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

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

Association of Low Thyroid Hormone with Migraine Headache

This cross sectional comparative study was done to investigate the association between low thyroid hormone level and migraine headache in adults patients. The study was conducted in Mymensingh Medical College Hospital, a tertiary level hospital of Bangladesh. Study period was from November 2017 to April 2018. The study subjects consisted of 50 patients with migraine headache as case, compared with 50 patients of headache other than migraine as control, seen in Neurology out patient department (OPD). Thyroid function test was performed by new automated immuno-chemiluminometric assay. Mean age was 29.80±9.87 years in migraine group and 34.18±11.82 years in non migraine group. Male female ratio was 1:2.3 and 1:1.7 in two groups. Level of TSH was significantly higher in migraine patients (3.52±2.53 vs. 2.25±2.13) than other headache patients (p=0.008). Thyroid disorder especially subclinical hypothyroidism was significantly higher (28% vs. 08%) in migraineurs than non migraineurs (p=0.032). No significant relationship was found between thyroid hormone level and headache characteristics of migraine patients (p>0.05). Migraine headache is associated with low thyroid hormone and thyroid disorder can be considered as comorbidity of migraine headache.

Level of Serum Vitamin D, To Which People Are at Risk of Developing Acute Myocardial Infarction in Bangladesh

Incidence of Myocardial Infarction is increasing day by day in developing countries. Most of the patients who sustain myocardial infarction have coronary atherosclerosis. There are several risk factors for the development of atherosclerosis. Among all the risk factors, vitamin D deficiency has been proposed to play an important role in the development of atherosclerosis. With this aim, a case-control study was carried out to explore the association of serum vitamin D with acute myocardial infarction. The enrolled study subjects were categorized into Group A which comprised of STEMI, Group B, comprised of NSTEMI and Group C comprised of age and sex matched individuals free from acute myocardial infarction. The mean values of serum vitamin D (in ng/ml) were 20.17, 20.8 and 24.77 respectively in STEMI, NSTEMI and control groups. It differed significantly among groups (p<0.001) and it was significantly low in STEMI and NSTEMI groups compared to control group (p<0.001 and p=0.004). From this study it can be concluded that low serum vitamin D is an independent risk factor for developing acute myocardial infarction. Individuals with serum vitamin D <20ng/ml have higher chance of developing acute myocardial infarction compared to those with serum vitamin D >20ng/ml.

Changing the landscape of tumor immunology: novel tools to examine T cell specificity

Immunotherapy has established itself as a stalwart arm in patient care and with precision medicine forms the new paradigm in cancer treatment. T cells are an important group of immune cells capable of potent cancer immune surveillance and immunity. The advent of bioinformatics, particularly more recent advances incorporating algorithms employing machine learning, provide a seemingly limitless ability for T cell analysis and hypothesis generation. Such endeavors have become indispensable to research efforts accelerating and evolving to such an extent that there exists an appreciable gap between knowledge and proof of function and application. Exciting new technologies such as DNA barcoding, cytometry by time-of-flight (CyTOF), and peptide-exchangeable pHLA multimers inclusive of rare and difficult HLA alleles offer high-throughput cell-by-cell analytical capabilities. These outstanding recent contributions to T cell research will help close this gap and potentially bring practical benefit to patients.

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

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

SHadow Under the Lamp (SHUL): Smoking behavior of the health professionals

Background

Smoking cessation is the best option a health professional can offer to the patients for averting the preventable causes of mortality and morbidity.

Purpose

To determine smoking behavior, preferred cessation methods, and attitudes towards smoking cessation amongst health professionals.

Methods

The cross-sectional study, conducted in six countries, included doctors and nurses working at different hospital settings. Participants responded anonymously to an online questionnaire.

Results

Among 1109 participants, 36% were from Saudi Arabia, 14% from Nepal, 14% from Indonesia, 12% from Australia, 12% from Jordan, and 12% from Pakistan. Mean age was 33 years, 61% were females and 58% were nurses. One in eight (12%) was daily smoker. Among current smokers, 42% smoked 2-9 cigarettes/day, and 26% had their first cigarette within 5-30 minutes after waking up. Half of the smokers perceived it as 'very important' to quit smoking, 30% had tried to quit in the last six months, and 31% preferred to have a group quit program with the same health professionals. Only 17% had formal training on smoking cessation, but 57% were interested to receive one. Half of the participants said they (53%) 'always' asked patients if they smoked, but 89% said they advised to quit, 76% said they assessed intention to quit, 28% said they assisted by providing materials on cessation, and 33% said they arranged follow up for cessation. Compared to current smokers, never smokers were more likely to 'always' ask patients if they smoked (78% vs. 22%, p = 0.044, ORs 1.39, 95%CIs 1.01-1.91), assist smokers by setting quit dates (74% vs. 26%, p = 0.039, ORs 1.54, 95%CIs 1.03-2.29), arrange follow up (77% vs. 23%, p = 0.044, ORs 1.40, 95%CIs 1.01-1.94).

Conclusions

Health professionals reported moderately good behavior around advice to smokers, but it is much worse among current smokers. Health professionals who smoke should be both encouraged to quit and to better support their patients to do so.

Key messages

Smoking cessation support for patients was not good among health professionals, who were smokers. Health professionals need to quit smoking in order to provide better cessation support for patients.

COVID 19: Importance of Physical Rehabilitation Medicine Capacity Building

No Abstract.

Oral Mucosal Graft Augmented Anastomotic Urethroplasty for Post Traumatic Urethral Stricture and Distraction Defect: Outcome in 100 Patients

The surgical procedures of post traumatic posterior urethral stricture and distraction defects range from the extremely simple to the extremely radical. In oral Mucosal Graft Augmented Anastomotic Urethroplasty (OMG AAU) the stricture segment is excised followed by partially re-anastomosis of the dorsal or ventral urethral wall then the reconstruction is completed by placement of oral mucosal graft into the remaining urethral defect. The aim of this study is to determine the impact and assess the effectiveness of this technique, discuss the procedure and outcome and to refine them where found lacking. A prospectively collected review of records was done from September 2010 to April 2019. A total 100 patients with post traumatic urethral stricture and distraction defect were treated by dorsal onlay oral mucosal graft augmented anastomotic urethroplasty by same surgeon in a single centre. All were followed up every 3 and 6 monthly for 1-2 years with uroflowmetry. Retrograde urethrogram/Micturating cysto-urethrogram (RGU/MCU) and cystoscopy were reserved for those who had complained of obstructive symptoms and uroflowmetry evidence of outflow obstruction. The etiology of trauma was road traffic accident (RTA) (69%), falling astride (28%) and traumatic catheterization (3%). Mean excised stricture length was 1.5cm (Range 1.0-2.2). The mean length of dorsal onlay considering excised stricture length and 1cm spatulations was 4.25cm (range 2.0-6.5). The successful recovery was observed in 94% cases. On conclusion the technique of OMG AAU is very easy to do, reliable and has high success rates. This is also the procedure of choice for long segment obliterative strictures. For post traumatic obliterative strictures and distraction defects we strongly recommend the procedure for successful and patient satisfactory outcome.

Landscape mapping of shared antigenic epitopes and their cognate TCRs of tumor-infiltrating T lymphocytes in melanoma

HLA-restricted T cell responses can induce antitumor effects in cancer patients. Previous human T cell research has largely focused on the few HLA alleles prevalent in a subset of ethnic groups. Here, using a panel of newly developed peptide-exchangeable peptide/HLA multimers and artificial antigen-presenting cells for 25 different class I alleles and greater than 800 peptides, we systematically and comprehensively mapped shared antigenic epitopes recognized by tumor-infiltrating T lymphocytes (TILs) from eight melanoma patients for all their class I alleles. We were able to determine the specificity, on average, of 12.2% of the TILs recognizing a mean of 3.1 shared antigen-derived epitopes across HLA-A, B, and C. Furthermore, we isolated a number of cognate T cell receptor genes with tumor reactivity. Our novel strategy allows for a more complete examination of the immune response and development of novel cancer immunotherapy not limited by HLA allele prevalence or tumor mutation burden.

The immune system is the body’s way of defending itself, offering protection against diseases such as cancer. But to remove the cancer cells, the immune system must be able to identify them as different from the rest of the body. All cells break down proteins into shorter fragments, known as peptides, that are displayed on the cell surface by a protein called human leukocyte antigen, HLA for short. Cancer cells display distinctive peptides on their surface as they generate different proteins to those of healthy cells. Immune cells called T cells use these abnormal peptides to identify the cancer so that it can be destroyed.

Sometimes T cells can lack the right equipment to detect abnormal peptides, allowing cancer cells to hide from the immune system. However, T cells can be trained through a treatment called immunotherapy, which provides T cells with new tools so that they can spot the peptides displayed by HLA on the previously ‘hidden’ cancer cells.

There are many different forms of HLA, each of which can display different peptides. Current research in immunotherapy commonly targets only a subset of HLA forms, and not all cancer patients have these types. This means that immunotherapy research is only likely to be of most benefit to a limited number of patients. Immunotherapy could be made effective for more people if new cancer peptides that are displayed by the other ‘under-represented’ forms of HLA were identified.

Murata, Nakatsugawa et al. have now used T cells that were taken from tumors in eight patients with melanoma, which is a type of skin cancer. A library of fluorescent HLA-peptides was generated – using a new, simplified methodology – with 25 forms of HLA that displayed over 800 peptides. T cells were then mixed with the library to identify which HLA-peptides they can target. As a result, Murata, Nakatsugawa et al. found the cancer targets of around 12% of the tumor-infiltrating T cells tested, including those from under-represented forms of HLA. Consequently, these findings could be used to develop new immunotherapies that can treat more patients.

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

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

The impact of ZnO configuration as an external layer on the sensitivity of a bi-layer coated polymer optical fiber probe

Salinity magnitude changes are a critical factor for determining the chemistry of natural water bodies and biological processes. Label-free refractive index sensors are promising devices for detecting these changes. A polymer optical fiber (POF) sensor modified with cladding treatment and a bi-layer zinc oxide/silver (ZnO/Ag) nanostructure coating to determine sodium chloride concentration changes through refractive index variations in water is experimentally demonstrated. The use of three ZnO nanostructure shapes, nanoparticles and horizontally and vertically oriented nanorods, as an external layer and a broad spectrum light source from the visible (Vis) to the near infrared (NIR) region are investigated to achieve optimum sensitivity. The rms roughness, optical band-gap and zeta potential (ZP) value for the vertically oriented sample are 148 nm, 3.19 eV and 5.96 mV, respectively. In the NIR region the wavelength–intensity sensitivity values of probes coated with ZnO nanoparticles and horizontally and vertically oriented nanorods are 104 nm RIU⁻¹–12 dB RIU⁻¹, 63 nm RIU⁻¹–10 dB RIU⁻¹ and 146 nm RIU⁻¹–22 dB RIU⁻¹, respectively, and in the Vis area the values are 65 nm RIU⁻¹–14 dB RIU⁻¹, 58 nm RIU⁻¹–11 dB RIU⁻¹ and 89 nm RIU⁻¹–23 dB RIU⁻¹, respectively. The maximum amplitude sensitivity is obtained for the probe coated with vertically aligned ZnO nanorods in the NIR area due to the deeper penetration of evanescent waves, a higher surface-volume ratio, better crystallinity, more adhesive interactions with salt molecules, larger surface roughness and higher-order dispersion compared to the other coated ZnO nanostructures.

Detecting the salinity magnitude changes as a predominant factor for determining the chemistry of natural water bodies and biological process via label-free refractive index modified optical fiber sensors.

Comparison of Serum Amylase and Lipase Levels between Predialysis and Maintenance Haemodialysis CKD Patients

This cross sectional study was done to compare serum levels of amylase and lipase between predialysis and maintenance haemodialysis chronic kidney disease (CKD) patients and also to find out their relationship between degrees of renal impairment in Mymensingh Medical College Hospital and National Institute of Kidney Diseases and Urology, Dhaka, Bangladesh from May 2016 to April 2017. A total of 80 patients were included purposively as study subjects and made into two groups namely predialysis CKD group comprising 50 patients and other as maintenance haemodialysis group comprising of 30 patients. Among the predialysis group majority of the CKD was caused by glomerulonephritis (48%) followed by diabetes (26%), HTN (2%) and large portion undiagnosed (24%) whereas in the haemodialysis group ESRD was caused by diabetes (46%) followed by glomerulonephritis (16%), HTN (13%) and undiagnosed (23%). This study showed that mean serum amylase (158±718U/L vs. 111±41U/L) did not significantly differ between study groups except being above reference level but serum lipase (739±888U/L vs. 434±214U/L) was significantly higher in the predialysis group. There was a correlation between rising serum creatinine with serum amylase and lipase.

An FBG magnetic sensor for oil flow monitoring in sandstone core

Monitoring the oil movement using a non-contact optical fiber probe during enhanced oil recovery is a novel technique to increase the efficiency of the process by distinguishing the oil position in the reservoir. A partially unclad fiber Bragg grating (FBG) coated with Fe₃O₄ nanoparticles as a magnetic field sensor is experimentally demonstrated. A series of six FBGs reflecting different wavelengths are fixed on the surface of sandstone. Nanofluids containing magnetite nanoparticles and alkaline-surfactant-polymer are injected continuously in two separate steps into the sandstone, which is saturated with 20% oil and 80% brine. The chamber is equipped with a solenoid that acts as a magnetic field generator. The changes in the magnetic field strength depended on the FBG-solenoid distance and the density of localized injected nanoparticles near the FBGs leads to a shift of the reflected wavelength of each single FBG accordingly. The shift is caused by the interference of different propagating modes reflected from the core-cladding and cladding-magnetite layer interfaces. The intensity of the FBG spectra decreases by injecting the nanofluid and vice versa for surfactant injection. The sensor response time of ∼21 s confirms the high reliability and repeatability of the sensing scheme. Movement of oil along the sandstone alters the wavelength shift in the FBG spectra.

Monitoring the oil movement using a non-contact optical fiber probe during enhanced oil recovery is a novel technique to increase the efficiency of the process by distinguishing the oil position in the reservoir.

Evaluation of Corrosion and Tarnishing of Intra-oral Nickel Chromium and Gold-alloy Cast Crown

Although esthetic factors might limit by the presentation of materials used, all-metal complete cast crown should always be offered to patients requiring restoration of endodontically treated posterior tooth. The complete cast crown has the highest longevity of all fixed restorations. It could be used to rebuild a single tooth or a retainer for a fixed prosthesis. It involves all the axial walls as well as the occlusal surface of the tooth to be restored. All restorations are placed in the oral environment in contact with the gingival tissue. Thus clinicians must choose nontoxic or least toxic metal alloys, since any release of elements that might cause reactions. This study was designed to observe clinical responses of nickel chromium alloy and gold alloy cast crown and provide guidance to ascertain the best alloy for cast metal crown, which serves better functional restoration.

Huge Splenomegaly with Pancytopenia Due to Gaucher's Disease in a 22 Years Old Woman

Gaucher's disease is one of the important storage disorders. It belongs to the lysosomal storage disorders group. There is defective activity of an enzyme named β-glucosidase which ultimately renders the cell of macrophage lineage loaded with glucocerebrosides. There is multi-organ involvement that manifests as hepatosplenomegaly, variable cytopenias, skeletal disorders, neurological features etc. When serum β-glucosidase level is below 15% of mean normal activity Gaucher's disease is confirmed. Enzyme replacement is the definitive treatment. Here we report a case of type 1 or non-neuropathic form Gauchers disease presented with feeling of a lump in left upper abdomen and progressive generalized weakness and hepatosplenomegaly. Her complete blood count revealed pancytopenia and bone trephine biopsy showed Gaucher's cells. Diagnosis and management may be delayed as this disease is rare. Clinical and bone marrow examination is the mainstay of diagnosis. So emphasis should be given in this regard.

Etiological Evaluation of Patients with Lymphadenopathy by Clinical, Histopathological and Microbiological Assessment

Lymph node enlargement is a common presenting complaint in outpatient and inpatient department. The present observational cross sectional study was conducted in department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period from December 2014 to May 2016 to evaluate etiologies of significant lymphadenopathy by clinical, histopathological and microbiological assessment. Biopsy/FNA materials of 177 patients of 18-75 years age range with significant lymphadenopathy were sent for histopathology/cytology, Gram stain & culture, AFB stain & culture and Gene Xpert. Among them, 102(57.62%) were granulomatous lymphadenitis, 52(29.38%) were lymphoma, 12(6.78%) reactive lymphadenitis, 7(3.95%) metastatic malignancy, 2(1.13%) atypical lymphoid hyperplasia, 1(0.57%) myeloid sarcoma and 1(0.57%) chronic sialadenitis. Growth of MTB was on 23(22.55%) cases; among 102 granulomatous lymphadenitis and Gene Xpert was positive in 73(71.56%) cases with 100% Rif. sensitive. Gene Xpert is an important tool for diagnosis of tuberculous lymphadenitis. Time of symptoms to diagnosis of most of the TBL patients was within 2-8 months.

Motor Outcome of Stroke Patients with Low Dose Levodopa Therapy

Stroke is one of the leading cause of disability worldwide. Motor function deficits due to stroke contribute to overall low quality of life. The objective was of this study is to observe functional motor outcome after stroke with low dose Levodopa therapy. This prospective follow up study was carried out in the Department of Neurology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2014 to June 2016 to see the effect of low dose of Levodopa (110mg) on motor outcome after stoke disability. Motor deficit was measured by Medical Research Council (MRC) grading and Rivermead Mobility Index (RMI) score. Two groups were selected by simple random method, consisted of both ischemic and hemorrhagic stroke. All the patients of both the groups were suffering from at least some post stroke motor disability and attended full course of physiotherapy. The group (L) received 110mg Levodopa with physiotherapy. On the other hand (NL) group received only physiotherapy. They were all followed up for four times within two months of time and were assessed for recovery of motor function. Mean age was 59.03±11.56 years in Levodopa (L) group and 57.10±12.41 years in the Non Levodopa (NL) group; Males were predominant in both groups. Ninety three (77.50%) cases had ischemic stroke and 27(22.50%) cases had hemorrhagic stroke. Most common risk factors were hypertension and smoking. No known risk factor was detected in 8 (6.67%) patients. Single or multiple risk factors were confirmed in 112 patients (93.33%). MRC score was significantly higher both in affected upper and lower limb in Levodopa group comparing non Levodopa group at 4th visit. RMI score was also significantly higher in Levodopa group comparing non Levodopa group at 4th visit. The Levodopa (L) group showed better recovery pattern than Non Levodopa (NL) group. It can be concluded that motor recovery was better with administration of a single low dose of Levodopa in combination with physiotherapy. Motor outcome was significantly higher in levodopa group than non-levodopa group.

Process based simulation of tree growth and ecosystem services of urban trees under present and future climate conditions

Global processes of urban growth lead to severe environmental impacts such as temperature increase with an intensification of the urban heat island effect, and hydrological changes with far reaching consequences for plant growth and human health and well-being. Urban trees can help to mitigate the negative effects of climate change by providing ecosystem services such as carbon storage, shading, cooling by transpiration or reduction of rainwater runoff. The extent of each ecosystem service is closely linked with the tree species as well as with a tree's age, size, structure and vitality. To evaluate the ecosystem services of urban trees, the process-based growth model CityTree was developed which is able to estimate not only tree growth but also the species-specific ecosystem services including carbon storage, transpiration and runoff, shading, and cooling by transpiration. The model was parametrized for the species small-leaved lime (Tilia cordata), robinia (Robinia pseudoacacia), plane (Platanus×acerifolia) and horse chestnut (Aesculus hippocastanum). The model validation for tree growth (stem diameter increment, coefficient of correlation=0.76) as well as for the water balance (transpiration, coefficient of correlation=0.92) seems plausible and realistic. Tree growth and ecosystem services were simulated and analyzed for Central European cities both under current climate conditions and for the future climate scenarios. The simulations revealed that urban trees can significantly improve the urban climate and mitigate climate change effects. The quantity of the improvements depends on tree species and tree size as well as on the specific site conditions. Such simulation scenarios can be a proper basis for planning options to mitigate urban climate changes in individual cities.

Clinical Scoring Versus Chlamydia Antibody Titre as a Tool in Predicting Tubal Patency in Subfertile Women

This study was done to compare the predictive capacity of Clinical scoring and Chlamydia antibody titre in predicting tubal patency. This cross sectional comparative study was done in Institute of Child and Mother Health, Dhaka, Bangladesh from January 2018 to December 2018. Eighty eight infertile women with normal ovarian reserve and their husbands with normal semen parameters were purposively included. After taking written informed consent, Clinical scoring, Chlamydia antibody titre and Hysterosalpingography of the study population were done. Data expressed as mean and standard deviation. Logistic regression analysis was done. The predictive capacity was analyzed by sensitivity, specificity, positive and negative predictive value and relative risk. Area under the Curve of Receiver Operating Characteristic was done. A p value <0.05 was considered as statistically significant. Fifty three and half percent had bilateral and 8% had unilateral tubal block and 38.5% had bilateral patent tubes. Clinical scoring versus Hysterosalphingography and Chlamydia antibody titre versus Hysterosalphingography of the study population had sensitivity 87.04% and 48.15%, specificity 76.47% and 58.82%, positive predictive value 82.95% and 52.27%, negative predictive value78.79% and 41.67% and relative risk 5.42 and 0.84 respectively. The Clinical Scoring is better than Chlamydia Antibody Titre as a tool in predicting tubal patency.