Pancreatic ductal adenocarcinoma: exploring clinicopathological trends and racial disparities in a comprehensive U.S. population-based study

INTRODUCTION

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy about 50% of PDAC are metastatic at presentation. In this study, we evaluated PDAC demographics, annual trend analysis, racial disparities, survival rate, and the role of different treatment modalities in localized and metastatic disease.

METHODS

A total of 144,824 cases of PDAC were obtained from the SEER database from 2000 to 2018.

RESULTS

The median age was 69 years, with a slightly higher incidence in males (52%) and 80% of all cases were white. Among cases with available data, 43% were grade III tumors and 57% were metastatic. The most common site of metastasis was the liver (15.7%). The annual incidence has increased steadily from 2000 to 2018. The overall observed (OS) 5-year survival rate was 4.4% (95% CI 4.3-4.6%), and 5 years cause-specific survival (CSS) was 5% (95% CI 5.1-5.4%). The 5-year survival with multimodal therapy (chemotherapy, surgery, and radiation) was 22% (95% CI 20.5-22.8%). 5-year CSS for the blacks was lower at 4.7% (95% CI 4.2-5.1%) compared to the whites at 5.3% (95% CI 5.1-5.4%). Multivariate analysis found male gender and black race associated with worse prognosis. Kaplan-Meier survival analysis found multimodal therapy to have the best outcomes in all three stages.

CONCLUSION

PDAC is an aggressive malignancy with male gender and black race are associated with a poor prognosis. Surgery with chemoradiation was associated with the best overall survival. With steadily increasing rates of PDAC, improved treatment modalities are paramount to improving survival in these patients.

Hypoalbuminaemia as a Marker of Severity of Patients of Community Acquired Pneumonia

Community-acquired pneumonia (CAP) is a common presentation with an acute infection of the pulmonary parenchyma occurring in the community level. Despite the availability of potent antibiotics, it remains as a serious illness with significant morbidity and mortality in both developed and developing countries. This study was undertaken to determine the relation between serum Albumin and severity of CAP. This was a cross sectional descriptive study which was carried out in the Department of Medicine of Mymensingh Medical College Hospital (MMCH), Bangladesh from July 2019 to December 2019. The sample size was 67. Purposive sampling technique was employed. Patients of community acquired pneumonia (CAP), aged ≥14 years of both sex with recently developed radiological pulmonary shadowing with compatible clinical symptoms and signs were included. Patients who were chronically immunosuppressed, with chronic starvation, advanced liver disease or chronic kidney disease with or without receiving haemodialysis were excluded. Data analysis was done by SPSS software for Windows (version 23.0). The mean age 65.7±15.3 years, majority 13(19.4%) patients had chronic lung disease, 12(17.9%) had diabetes mellitus, 9(13.4%) had heart failure, 6(9.0%) had cerebrovascular disease, 6(9.0%) had neoplastic disease and 5(7.5%) had chronic renal failure. Majority 22(32.8%) patients had CURB-65 score 3, out of which 12(54.5%) had albumin level <20g/l, 9(40.9%) had albumin level 20.0-24.9g/l and 1(4.5%) had albumin level 25-29g/l. 17(25.4%) had score 4-5 out of which 10(58.8%) had albumin level <20g/l and 7(41.2%) had albumin level 20.0-24.9g/l, 15(22.4%) had score 2 and 13(19.4%) had score 0-1. Negative significant correction (r=-0.782; p=0.001) was found between CURB-65 score and albumin level. Significant number of patients with severe CAP show low serum albumin level at admission which is statistically significant when compared with CURB-65 score. Thus hypoalbuminaemia may be a good marker of severity of patients with CAP.

Enhancement of resilience and quality of cold supply chain under the disruptions caused by COVID-19: A case of a developing country

Cold supply chain (CSC) comprises temperature-sensitive processes, starting from the supply of raw materials, manufacturing, and finally the delivery of finished goods to the end consumers via transport services. Pandemics such as COVID-19 pose threats to its overall functioning and to cater to this issue, the study will ensure the sustainable functioning of CSC by recommending resilience strategies. To do so, the COVID-19 disruptions in the CSC and the resilient sustainability strategies were collected via a vigorous literature review and were analyzed via a Fuzzy QFD technique. The results concluded “crisis simulation,” “identification and securing of logistics,” and “digitalization of cold supply chain” as the top three strategies to ensure the resilience of CSC under disruptions caused by COVID-19. The study recommends necessary steps to the policymakers to ensure a resilient and quality effective CSC. The application of the study proves to be the first of its kind in a developing country such as Pakistan.

JEL Classification: C54, D81, H12

Incidence and molecular characterization of extended-spectrum beta-lactamase (ESBL)-producing Salmonella enterica and Escherichia coli of avifauna origin in Pakistan

Members of Enterobacteriaceae are known to produce extended-spectrum beta-lactamases (ESBL) which hydrolyze the beta-lactam group of antibiotics. The existence of ESBL-producing Salmonella enterica (S. enterica) and Escherichia coli (E. coli) harbored by urban avifauna was investigated in this study. Dropping samples (n= 180) were collected from six different bird species in the district Jhang, Punjab province, Pakistan. Isolation and identification of ESBL isolates were made by using cefotaxime- (4 mg/L) supplemented MacConkey agar and double disc synergy test (DDST). Polymerase chain reaction (PCR) was performed for the detection of four different ESBL genes including blaCTX-M, blaTEM, blaSHV and blaOXA. A total of 42.69% isolates were confirmed as ESBL via DDST including 30.64% S. enterica and 49.54% E. coli. The incidence of ESBL S. enterica and ESBL E. coli was found highest in egret (Ardea alba) and pigeon (Columba livia) as 64.28% and 78.95%, respectively. The blaCTX-M gene was detected in 57.89% and 64.81% of isolates of S. enterica and E. coli, respectively. Among other genes in S. enterica and E. coli, blaTEM (21.05%, 20.4%); blaSHV (15.78%, 9.26%), and blaOXA (5.26%, 5.56%) were detected, respectively. All of the tested isolates were found resistant to at least one of the thirteen antimicrobial agents except meropenem. To the best of our knowledge, this is the first study reporting the incidence and genetic diversity of ESBL bacteria associated with urban avifauna in Pakistan. The urban avifauna can serve as a potential subject of bio-surveillance to monitor the emergence of antimicrobial-resistant bacteria.

Bone markers and bone mineral density associates with periodontitis in females with poly-cystic ovarian syndrome

INTRODUCTION

Studies suggest an association between poly-cystic ovarian syndrome (PCOS) and chronic periodontitis (CP), both being inflammatory conditions. However, insufficient evidence assesses the impact of this inflammation on bone metabolism and bone turnover markers (BTMs). The present study aimed to determine the association between BTMs, bone mineral density (BMD), and clinical periodontal parameters in PCOS women with CP.

MATERIALS AND METHODS

Three groups, each with 40 newly diagnosed (1) PCOS+CP, (2) PCOS alone, (3) CP alone, and fourth group (n = 20) systemically and periodontally healthy females aged 18-30 years were included in the study. Full mouth clinical periodontal parameters, C-terminal telopeptides of type I collagen (CTX), bone alkaline phosphatase (ALP), BMD and 25-hydroxyvitamin D (VD) were recorded for all.

RESULTS

Low BMD (0.89 ± 0.11 g/cm²), increased CTX levels (2.76 ± 4.64 ng/ml), decreased bone ALP levels (11.09 ± 6.86 ng/ml), higher VD levels (289.02 ± 168.28 nmol/l) and poor clinical periodontal status were observed in PCOS + CP females. BMD-spine showed weak positive correlation with CTX, bone ALP, VD (r = 0.02, r = 0.07, r = 0.15, respectively) in PCOS + CP group. ANCOVA depicted covariates had no confounding effect. Multiple regression model explained 21.0% for BMD-spine and 12.7% for BMD-femur of total variability signifying association with all measured parameters among all groups.

CONCLUSION

Enhanced inflammatory thrust by periodontitis increases CTX levels and decreases bone ALP and BMD levels in women with PCOS. Screening PCOS women for periodontal disease and vice versa may have a direct bearing on overall bone health.

Elucidating antiviral activity of Curcuma longa against H9 N2 influenza virus using embryonated chicken egg model

Curcumin is a potent antimicrobial herb used traditionally as a spice in culinary. This study was designed to evaluate the antiviral effects of curcuma longa extract against H₉ influenza virus. A total of 60 embryonated eggs were equally divided into 5 groups with 12 eggs in each group. Group 1 (G1) served as uninfected negative control. Whereas Group 2 (G2) was kept as positive control infected with known virus @ 0.2 ml with 10^-9.3 EID₅₀. Group 3 (G3) was offered Curcuma longa @ 0.2 mg/0.2 ml and H₉N₂ virus (@ 0.2 ml with 10^-9.3 EID₅₀. Similarly, Group 4 (G4) was inoculated with extract of Curcuma longa @ 0.2 mg/0.2 ml per egg, whereas Group 5 (G5) was given Ribazole @ 0.2 ml/ egg. The crude extract and virus were administered on the 15^th day of incubation and were checked after every 24 hours up to 96th hour post inoculation by random selection of 3 eggs. Death and survival rate were noted in all groups. Gross and histopathological lesions were also observed. Results revealed that Curcuma longa extract had significantly (p<0.05) reduced the mortality rate of embryos infected with H₉N₂ virus. In G3, increased lymphocytes and mild fatty changes were seen in liver. Whereas, mature RBCs, plasma cells and some lymphoblast's were observed in Spleen. Similarly, the bursa follicles were with lymphocytic aggregation. The G4 (Curcuma longa) and G5 (Ribazole) were with maximum embryo survival after 48 and 72 h post inoculation. This study revealed potential antiviral activity of Curcuma longa against H9N2 influenza viruses and can be opted as alternative to antibiotics and antiviral drugs to minimize the antimicrobial resistance in human and animal population.

PCR-RFLP Based genetic diversity of Plasmodium vivax genotypes in district Mardan, Pakistan

Plasmodium vivax is the most common human malaria parasite in Asian countries including Pakistan. Present study was designed to explore the genetic diversity of plasmodium vivax genotypes based on Pvmsp-3α and Pvmsp-3βgenes using allelic specific nested PCR and RFLP assays markers from field isolates in district Mardan, Pakistan. Blood samples of 200 P. vivax malarial patients were collected after taking their written informed consent. Genetic diversity in nested PCR products was determined by Restriction Fragment Length Polymorphism (RFLP) utilizing Alu1 and PstI restriction enzymes for alpha and beta gene products digestion, respectively. For analysis the genetic diversity of the sub allelic variants of Pvmsp3α and Pvmsp3β genes, Chi-Square test was performed by utilizing Minitab programming software 18. The P value 0.05 was considered as statistically significant. For Pvmsp-3α genes after gel electrophoresis of digested products, four distinct genotypes were obtained from total of 50 samples; type A: 35 (70%) (1.5-2.0 kb), 12 of type B (24%) (1.5-1.7 kb), 2 of type C (4%) (0.5-1.5) and one for type D (2%) (0.5-0.65 kb) which could be characterized into 9 allelic pattern (A1-A4, B1-B3, C1, D), in which A3 remained the most predominant. For Pvmsp-3βgenes, three distinct genotypes were obtained from 50 samples; 40(80%) of type A (1.5-2.5 kb), 9 (18%) of type B (1.0-1.5kb) and 1(2%) of type C (0.65 kb) which could be characterized into 6 allelic patterns (A1-A3, B1-B2, and C1). Most dominant one in Type A was A1 alleles which were noted (46%), while in Type B, the most dominant were B1 (10%).This study is the first ever report of molecular epidemiology and genetic variation in Pvmsp-3α and Pvmsp-3β genes of P. vivax isolates by using PCR/RFLP from District Mardan and showed a remarkable level of genetic diversity in the studied genes of circulating parasites in the study area. The results of this study will contribute in future studies about the genetic structure of parasite and vaccine development against the malaria.

Sustainable production of diapers and their potential outputs for the Pakistani market in the circular economy perspective

One of the challenging issues of any country's agenda today is the management of solid waste in the circular economy and eco-efficiency perspective. In this context, there has been much debate about the disposal of diapers, but the current research lacks data for developing countries. Furthermore, the research lacks quantification of data, in terms of output products generated through sustainable waste management practices particularly for diapers. Thus, this research aims to develop a quantitative study based on Life Cycle Assessment (LCA) and Life Cycle Costing Analysis (LCCA) which help to evaluate the overall eco-efficiency of various disposal methods by taking into account their net input and resultant monetary value, in the context of Pakistan. To cover limitations of LCA approach, results have been compared along with the expert's opinion using the well-known multi-criteria method Fuzzy logic and Technique for Order of preference by similarity to ideal solution (TOPSIS) technique. Human health and environment have been used as end-point indicators. The main research result points out that incorporating small scale incineration plants along with recycling using Thermal Pyrolysis Hydrolysis (TPH) plants can help to sustainably dispose-off diapers. The results also indicate the importance for policy makers and industrial sector to find solutions to facilitate implementation of circular economy principles for diapers. In fact, the recycling of diapers using waste-to-energy technologies is a significantly eco-efficient alternative for the Pakistani market, which can be pivotal for Sustainable development and initiation of a circular economy model.

321 Role of Antibiotics in Acute uncomplicated diverticulitis, A Systematic Review and Meta-Analysis

Introduction

Diverticular disease is a common health problem with a wide clinical spectrum. About 75% of the patients would have uncomplicated diverticulitis. Cornerstones of treatment are antibiotics, analgesia, and dietary advice. Recent evidence has shown that its treatment is controversial, questioning the use of antibiotics. Aim is to assess the role of antibiotics in the treatment of acute uncomplicated diverticulitis.

Method

This is a systematic review and Meta-analysis. Literature review of the available studies was conducted using search engines like Pubmed, Medline, Embase, Google Scholar, and Cochrane databases. Statistical analysis was conducted using RevMan5.4.

Results

Out of 1754 records 1324 were duplicates, 430 studies were screened. 395 were further excluded.35 full text articles were assessed and in the final review 10 studies were included. PRISMA guidelines were used. Pooled OR for recurrence = 0.92 (95% CI = 0.74 to 1.13). Pooled OR for Hospital stay= -0.66 (95% CI= -1.12 to -0.21). Pooled OR for complications = 1.06 (95% CI = 0.69 to 1.64). Pooled OR for treatment failure= 1.24 (95% CI = 0.90-1.69).

Conclusions

We conclude that from the available evidence antibiotics have no role in reducing recurrence, complications, treatment failure, and duration of hospital stay in acute uncomplicated diverticulitis.

Clinicopathological Findings of Haematological Malignancies in Hospital Admitted Patients

The global burden of cancer is gradually rising. In our context we are also facing the same problem. Hematological malignancies (HMs) are important component of cancer. Early diagnosis and proper treatment at right time, a good number of HMs patients can be cured or lengthening the survival period. For this purpose a proper diagnostic criteria should be developed in our settings. This research work is carried out to find out the clinicopathological findings of HMs in our population. This was a cross-sectional descriptive type of observational study conducted in the Department of Medicine and Hematology of Mymensingh Medical College Hospital, Bangladesh from July 2016 to June 2017. Total 45 patients were purposively selected on the basis of inclusion and exclusion criteria with a view to observe the clinical and laboratory findings. Mean age of the patients was 44.5 years. Highest average age (70 years) was found in chronic lymphocytic leukaemia (CLL) and lowest (29 years) in acute lymphoblastic leukaemia (ALL). Majority of the respondents were male in all HMs except in non-Hodgkin's lymphoma (NHL) where male-female ratio was 0.3:7. Among male most of them were farmers or day laborers and most of the females were housewife. Almost all patients were exposed to single or multiple exposures like smoking, betel nut, betel leaf, tobacco leaf, fertilizer or pesticides. Acute myeloblastic leukaemia (AML) was the leading HMS with 31.11% representation followed by non-Hodgkin's lymphoma (NHL) 20%, Hodgkin's lymphoma (HL) 15.56%, acute lymphoblastic leukaemia (ALL) 11.11%, chronic myeloid leukaemia (CML) 11.11%, multiple myeloma (MM)6.67% and chronic lymphocytic leukaemia (CLL) 4.44%. Duration of symptoms was vary from 2 days to 5 years. In acute leukaemia duration was short (average 2 months). Common clinical findings were anaemia (95.5%), fever (80.0%), hepatosplenomegaly (42.2%), lymphadenopathy (40.0%), bony tenderness (22.2%) and bleeding manifestations (15.5%). Some uncommon findings were also reported like menorrhagia, facial nerve palsy, arthritis and disorientation. Common laboratory abnormalities were high ESR, anaemia, leukocytosis, thrombocytopenia and immature cell in PBF especially in acute leukaemia. Clinical suspicion along with history of positive exposure indicates strong possibilities of haematological malignancies. It should be kept in mind that haematological malignancies may also present with some isolated uncommon findings.

ANALYTICAL HIERARCHY PROCESS (AHP) AND ANALYTIC NETWORK PROCESS METHODS AND THEIR APPLICATIONS: A TWENTY YEAR REVIEW FROM 2000-2019

This research aims to analyze a literature review of publications that have incorporated the Analytical Hierarchy Process (AHP) and Analytic Network Process (ANP) methods. The AHP and ANP methods have contributed to decision-making in complex situations in recent years and possess widespread applications. Such applications are spread over the years with publications in various major areas such as engineering/technology/applied sciences, social sciences, health sciences, and environmental studies. These two methods provide multiple solutions to researchers in these fields, which is why they are being considered in the current study. For this purpose, data was collected from 920 research papers after a vigorous literature review using different search engines. This paper aims to classify the publications on AHP and ANP methods from the years 2000 to 2019 to identify recognized journals based on their indexes. Furthermore, another objective of this study is to compare total publications by year, publications by field by year, and lastly, observe the distribution by country of the studies. This paper concludes that the highest number of publications are from Turkey, and the highest number of publications used AHP method applications in every category. Most of the publications belonged to the technical fields, followed by social sciences. The study concluded that the AHP method is more widely preferred by researchers in almost every field and application because it tends to produce more accurate results than the ANP.

Impact of Lean, Six Sigma and environmental sustainability on the performance of SMEs

Purpose

This paper aims to explore the impact of lean, Six Sigma and environmental sustainability on the performance of small and medium enterprises (SMEs) in Pakistan. The firm performance has been measured in terms of operational, business and environmental performance.

Design/methodology/approach

A survey-based methodology is adopted for collecting data from the main cities of Punjab, Pakistan. SMEs related to different industries such as service, manufacturing, automotive and retail were targeted. The data gathered were ordinal, and Spearman's correlation test was used as the data analysis technique.

Findings

The findings indicated that the three management styles positively impacted the environmental performance of SMEs. Moreover, no significant relationship was found between the three management styles and the SMEs' business and operational performance.

Research limitations/implications

To counter the inefficient and wasteful practices of SMEs and their detrimental impact on overall firm performance, SMEs have to refocus and reconfigure their management strategies. It is implied to use lean, Six Sigma and environmental sustainability practices to achieve this goal.

Originality/value

The study empirically investigates the impact of lean, Six Sigma and environmental sustainability on the performance of SMEs in Pakistan, which is the first study to be conducted in the Pakistani context.

CAN INDIA-PAKISTAN SPORTS PROMOTE PEACE? A MCDM APPROACH

Sports is an effective vehicle that is being adopted by almost every country to improve ties with other countries. India and Pakistan share a long border, but do not share a very pleasant history.  Over the years, these two countries have shared a fierce rivalry and no measures that have been taken have had a long-term positive impact on their relationship. None of the attempts at reconciliation have proved to be completely successful, and the relationship remains unbalanced. The factors that can improve the ties between the two countries are numerous, and sports is one of them. The objective of this study is to determine how much of an influence cricket, being the most popular sport in both countries, has on the overall relationship between them. For this purpose, data was gathered from people from both countries through a questionnaire-based survey and then analyzed by MCDM approaches like AHP (Analytic Hierarchy Process) and TOPSIS (Technique for Order Performance by Similarity to Ideal Solution). After performing the quantitative analysis, the study hopes to come to a solid conclusion about what people from both countries think about which alternative has the greatest influence on the ties between the two countries, and how the selected factors are influenced by the type of cricket matches played between India and Pakistan.  The positive results obtained from this research could be of great importance for the governments as well as for the people of both countries. This can divert the minds of people and politicians from all the controversies and wars in the past, and help move towards more healthy competition on the sports field.

THE BEST MANUFACTURING PROCEDURE FOR THE COMMERCIAL PRODUCTION OF UREA, USING AHP BASED TOPSIS

Nitrogen is one of the most significant nutrients needed for the proper growth and development of crops and other plants. In synthetic nitrogen fertilizers, solid urea is the largest source of nitrogen (N) as a nutrient. Prilling, granulation, and hybrid systems are the commercial processes used for the production of urea. One of the biggest challenges involved in the determination and implementation of those alternatives is rationalized decision making.  The objective of this research study is to evaluate these processes by considering some of the significant attributes like profit, environmental friendliness, process flexibility and reliability to determine which process is the most optimal. The results show that the prilling process is the best technology for urea production. It is the most optimal process in terms of profitability and reliability, and is therefore widely used in the fertilizer industry. Prilling is not the best option when it comes to the environment when compared to granulation. The granulation process is not the best fit for the commercial production of urea because it is not a reliable process, especially for high agricultural demands and market competition. The results show that it would be very difficult to keep up with the rapid growth of the population using the granulation process. If the environmental and urea quality concerns are considered, the hybrid system is the highest priority and may be preferred.    

Estimation of Vitamin D levels among Physicians Working in a Tertiary Level Hospital of Bangladesh

Vitamin D is essential for the body to regulate calcium and phosphate levels and mineralization of bone. It is synthesized in the skin after ultraviolet radiation exposure or obtained in the diet to a less extent. Vitamin D deficiency is attracting attention due to higher prevalence in different populations. Physicians of Bangladesh are supposed to be vulnerable to low Vitamin D levels owing to long indoor work hours in both government and private settings. The study was conducted to evaluate Vitamin D status among physicians working in a tertiary level public hospital of Bangladesh. The cross sectional descriptive study was carried out at Mymensingh Medical College Hospital during the period of January 2018 to June 2018. Data were collected from purposively selected 102 doctors of different levels using a case record form. Interview, measurements and laboratory investigations were done accordingly. Vitamin D levels were categorized as deficient (<20.00ng/L), Insufficient (20.00-29.00ng/L), Sufficient (30.00-100.00ng/L) and Potential Toxicity (>100.00ng/L). Among 102 doctors 79(77.5%) were male and 23(22.5%) were female. Maximum (60.8%) were in the age group of 31 years to 50 years. Mean±SD age of the subjects was 49.9±3.61years. Vitamin D deficiency was found in 19(18.6%) subjects and insufficiency was in 49(48.0%) of the subjects. On the other hand 34(33.3%) subjects had sufficient Vitamin D levels. Potential Vitamin D toxicity was not found in any of the subjects. Vitamin D deficiency was found more in female (30.4%) than male (15.2%) but insufficiency was found more in male (50.6%) than female (39.1%). The study revealed that 66.6% physicians had either deficiency or insufficiency of Vitamin D. Exposure to sunlight, dietary intake and Vitamin D supplementation should be considered to increase the status of Vitamin D levels in Physicians of Bangladesh.

Rotating flow of Ag-CuO/H2O hybrid nanofluid with radiation and partial slip boundary effects

The main object of the present paper is to examine and compare the improvement of flow and heat transfer characteristics between a rotating nanofluid and a newly discovered hybrid nanofluid in the presence of velocity slip and thermal slip. The influence of thermal radiation is also included in the present study. The system after applying the similarity transformations is solved numerically by using the bvp-4c scheme. Additionally, numerical calculations for the coefficient of skin friction and local Nusselt number are introduced and perused for germane parameters. The comparison between water, nanofluid and hybrid nanofluid on velocity and temperature is also visualized. It is observed that the velocity and temperature distributions are decreasing functions of the slip parameter. Temperature is boosted by thermal radiation and rotation. It is found that the heat transfer rate of the hybrid nanofluid is higher as compared to the traditional nanofluid.

Blackleg in cattle: Current understanding and future research perspectives- A review

Blackleg is an endogenous acute infection that principally affects cattle. The disease is caused by Clostridium chauvoei (C. chauvoei), an anaerobic spore forming bacterium. Control of this disease is based on stringent husbandry measures and scheduled vaccination plan. In recent years, the major virulence factors of C. chauvoei have been discovered and described. However, the pathogenesis of blackleg in cattle and in particular, circulation of the pathogen from point of entry to target tissues is yet not fully elucidated. This review summarizes the latest review of literature that significantly contributed for understanding the disease in cattle, and provides a foundation to preventive strategies.

Prevalence of GERD in Type II Diabetes Mellitus Patients Admitted in A Tertiary Care Hospital of Bangladesh

Gastroesophageal reflux disease (GERD) is defined as symptoms or complications associated with regurgitation from the stomach and/or the duodenum to the esophagus. Patients with type II diabetes mellitus (DM) were known to have higher prevalence of GERD in the Western countries, but data on the impact of GERD on DM patients in our country are scarce. The aim of this cross-sectional study was to evaluate the presence of GERD in type II DM patients admitted at the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from April 2015 to September 2015. A total of 137 type II DM cases were purposively collected. Reflux Disease Questionnaire (RDQ) was used to check the presence of GERD. Patient's characteristics, laboratory data, face-to-face interview data were analyzed. Out of 137 type 2 DM patients 108 were suffering from GERD giving a prevalence rate of 78.8% which is quite high. Pathophysiological factors like age, sex, duration of DM, weight, waist circumference (WC) had no significant difference between GERD-DM and non-GERD-type II DM patients. Only hypertension and frequent eating fatty food were found to have significant differences between the two groups. From the study findings it could be said that the higher rate of GERD in patients with type II DM may be associated with lifestyle factor and some pathophysiological factors like hypertension. Psychiatric factors may also play role in contributing GERD. Further in-depth and large scale studies are necessary in our country in this regard.

Modified Blatchford Score for Risk Stratification in Adult Patient with Nonvariceal Upper Gastrointestinal Haemorrhage and Their Short Term Hospital Outcome

Upper gastrointestinal hemorrhage (UGIH) is one of the most common and life-threatening gastrointestinal emergency. There are several risk scores for risk stratification in UGIB patients. The Modified Blatchford score, which relies only on clinical and laboratory parameters, is practical in the emergency setting The Modified Blatchford scoring system also known as Glasgow Blatchford Scoring (GBS) have been developed to stratify risk of non variceal upper gastrointestinal hemorrhage or need of medical or surgical intervention, endoscopic therapy. Objective of this study is to see risk stratification by The Modified Blatchford score and short term hospital outcome in non variceal upper GI hemorrhage patients. The observational study was carried out over a period of 6 months from October, 2014 to March, 2015 in Department of Department of Medicine, Gastroenterology and Surgery Mymensingh Medical College Hospital, Mymensingh. A total of 120 patients with non variceal UGIH were taken for the study during study period. Categorical variables were reported as percentage and Means and proportions were carried out using the Chi-square test (X2-test) of different variables by SPSS software version-18.0. Patients related variables age, sex; and main outcome variables the Modified Blatchford scoring system, Risk stratification, and short term hospital outcome were observed. Age frequency among total cases were 66(55%) <60 years, 50(41.67%) from 60-79 years and 4(3.3%) 80 years or above and sex distribution were 84(70%) were male and 36(30%) were female patients. Blatchford score of patients 1(0.83%) had score 0, 1(0.83%) had score 1, 2(1.67%) had score 2, 2(1.67%) had score 3, 2(1.67%) had score 4, 3(2.5%) had score 5, 12(10%) had score 6; 15(12.5%) had score 7, 16(13.33%) had score 8, 17(14.17%) had score 9, 16(13.33%) had score 10, 15(12.5%) had score 11, 10(8.33%) had score 12, 4(3.33% ) had score 13, 1(0.83%) had score 14, 2(1.67%) had score 15 and 1(0.83%) had score 16. Risk stratification showed 54(45%) had low risk (Mean GBS score 6.19±1.79), 66(55%) had high risk (Mean GBS score 11.03±1.83) Outcome of the patients were observed that 1(0.83%) died, 54(45%) was discharged without any medical or surgical intervention, and 65(54.17%) patients' needs medical or surgical intervention such as blood transfusion and endoscopy. Among total 120 patients with upper GI hemorrhage I have found that GBS score of three or less than three is predictive of low risk of adverse outcomes and can be discharged without any intervention.

The Ti-Mn system revisited: experimental investigation and thermodynamic modelling

As the Ti-Mn phase diagram is part of numerous ternary and higher order systems of technological importance, the present paper defines phase relations which have been experimentally established throughout this work from 800 °C to the melting range based on Differential Thermal Analyses (DTA), X-ray powder diffraction, metallography and Electron Probe Micro Analysis (EPMA) techniques on ∼50 alloys, which were prepared by arc melting or high frequency melting under high purity argon starting from freshly cleaned metal ingots. Novel compounds were identified and reaction isotherms were redefined accordingly. In the Ti-rich region a novel compound TiMn was detected, sandwiched between the known phases: TiMn1-x (∼45 at% Mn) and TiMn1+x (∼55 at% Mn). In the Mn-rich region the hitherto unknown crystal structure of TiMn∼3 was solved from X-ray single crystal diffraction data and found to be of a unique structure type Ti6(Ti1-xMnx)6Mn25 (x = 0.462; space group Pbam (#55); a = 0.79081(3) nm, b = 2.58557(9) nm, c = 0.47931(2) nm), which consists of two consecutive layers of the hexagonal MgZn2-type Laves phase (TiMn2) and a combined layer of alternate structure blocks of MgZn2 type and Zr4Al3 type. Whereas TiMn can be considered as a line compound (solubility range <∼1 at%), the homogeneity regions of the Ti-Mn compounds are significant (determined by EPMA): TiMn1-x (44.0 to 46.6 at% Mn), TiMn1+x (54.6 to 56.3 at% Mn), Ti1+xMn2-x (MgZn2-type, 59 to 69 at% Mn at 1000 °C: -0.08 < x < 0.23), TiMn∼3 (unique type; 74 to 76.5 at% Mn) and TiMn∼4 (R-phase: Ti8(TixMn1-x)6Mn39, 80 to 84 at% Ti). Supported by ab initio calculations of the ground state energy for the Laves phase, the new experimental results enabled thermodynamic modelling of the entire Ti-Mn phase diagram providing a complete and novel set of thermodynamic data thus providing a sound basis for future thermodynamic predictions of higher order Ti-Mn-X-Y systems.

Solid pseudopapillary tumour of pancreas

Solid pseudopapillary tumour of pancreas (SPT) is an extremely rare pancreatic tumour, which has a low malignant potential and occurs mainly in young women. Pathologic and imaging findings include a well defined encapsulated pancreatic mass with cystic and solid components with evidence of haemorrhage. This is a case of a 16 years old girl who presented with upper abdominal pain of long duration and epigastric mass on palpation. Computed Tomography (CT) scan demonstrated a large well defined heterogenous attenuation mass of solid enhancing and cystic non enhancing areas, arising from the head of the pancreas. Radiologically it was diagnosed as a case of pancreatic neoplasm. Fine needle aspiration cytology (FNAC) and histopathology of the biopsy material diagnosed as solid pseudopapillary tumour of pancreas.

Clinical profile of periodic paralysis

This cross sectional descriptive study was done to find out common clinical presentations, etiologies and laboratory investigation abnormalities in patients of periodic paralysis. Study was carried out in 30 patients with an age range from 8 to 70 years who were enrolled from July 2008 to June 2009 in Mymensingh Medical College Hospital (MMCH) medicine unit. Individuals who were admitted with sudden onset generalized muscle weakness, had history of previous attack and serum potassium level <3mmol/l or >5.5mmol/l were included in this study. In this series, majority of the patients were male (66.67%). Male: female ratio was approximately 2:1. The mean age of the patients was 27.4±4.5 years. Majority (26.67%) of them were in age range of 31-40 years. About 30% of the patients experienced the first attack of paralysis at the age of 20-24 years. Majority of patients (53%) were from middle class family with occupation of private service (26.66%) and farmer (20%). Positive family history was reported in 20% of patients. Regarding the precipitating factors, majority of patients (83.3%) were related to high carbohydrate meal, 56.67% related to temperature, 41.67% to exercise. Flaccid muscle weakness with variables muscle power (MRC grade 4/5 to 2/5 in 60% and 1/5 to 0/5 in 40%) was found. Cerebellar functions, all modalities of sensations and functions of cranial nerves were intact in all patients. In this series, laboratory investigations revealed reduced serum potassium level (<3mmol/l) in 90% of patients. Serum potassium value >5.5mmol/l was found in only 3.33% of patients. Creatine kinase (MM) was raised in 23% of the patients and Thyroid stimulating hormone (TSH) level was 0.8-2mmol/l in 6% of the patients. More than half of the patients (56%) showed variable ECG changes. Impaired nerve conduction function was found in 28.00%. So, careful history taking, meticulous clinical examination and simple laboratory investigations is sufficient to make a prompt diagnosis and rapid management of patients with periodic paralysis.

Prevalence of integrons, blaCTX-M and blaTEM resistance markers among ESBL-producing uropathogenic Escherichia coli isolates: first report of genomic blaCTX-M from India

Integrons have been observed to be frequently associated with uropathogenic bacteria. This study aimed at 1) determining the prevalence of class 1 integrons among ESBLl-producing uropathogenic Escherichia coli, and 2) analyzing resistance genes associated with different phylogenetic groups of the integron-positive isolates with special reference to bla(CTX-M) and bla(TEM). Twenty-three ESBL-producing E. coli were studied. Enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR) displayed 14 major patterns. Pulse field Gel electrophoresis-typing of 8 randomly selected integron-positive strains ruled out any correlation between genotype and antibiotype. Genomic DNA from 14 strains was PCR-positive for class 1 integrons, bla(CTX-M-15) and bla(TEM-1)-like genes. Integron-sequencing revealed "aadA5-dfrA17-dfrA7" as the most prevalent gene cassette. Our findings unveil the increasing role of the bla(CTX-M) genes in antibiotic resistance and emphasize on the significance of appropriate empirical treatment for Urinary tract infections. Moreover, this is the first study which reports bla(CTX-M) located on genomic DNA of bacteria from India.