The utility and accuracy of ChatGPT in providing post-operative instructions following tonsillectomy: A pilot study

OBJECTIVE

To investigate the utility of answers generated by ChatGPT, a large language model, to common questions parents have for their children following tonsillectomy.

METHODS

Twenty Otolaryngology residents anonymously submitted common questions asked by parents of pediatric patients following tonsillectomy. After identifying the 16 most common questions via consensus-based approach, we asked ChatGPT to generate responses to these queries. Satisfaction with the AI-generated answers was rated from 1 (Worst) to 5 (Best) by an expert panel of 3 pediatric Otolaryngologists.

RESULTS

The distribution of questions across the five most common domains, their mean satisfaction scores, and their Krippendorf's interrater reliability coefficient were: Pain management [6, (3.67), (0.434)], Complications [4, (3.58), (-0.267)], Diet [3, (4.33), (-0.357)], Physical Activity [2, (4.33), (-0.318)], and Follow-up [1, (2.67), (-0.250)]. The panel noted that answers for diet, bleeding complications, and return to school were thorough. Pain management and follow-up recommendations were inaccurate, including a recommendation to prescribe codeine to children despite a black-box warning, and a suggested post-operative follow-up at 1 week, rather than the customary 2-4 weeks for our panel.

CONCLUSION

Although ChatGPT can provide accurate answers for common patient questions following tonsillectomy, it sometimes provides eloquently written inaccurate information. This may lead to patients using AI-generated medical advice contrary to physician advice. The inaccuracy in pain management answers likely reflects regional practice variability. If trained appropriately, ChatGPT could be an excellent resource for Otolaryngologists and patients to answer questions in the postoperative period. Future research should investigate if Otolaryngologist-trained models can increase the accuracy of responses.

Analysis of Socio Demographic Risk Factors of Cervical Intraepithelial Neoplasia at Colposcopic Clinic in Mymensingh Medical College Hospital

Cervical intraepithelial neoplasia (CIN) is a pre-malignant lesion of the cervix of uterus. Several risk factors increased the risk of developing CIN. Purpose of this study was to evaluate the socio-demographic risk factors related to CIN at our setting. This Cross sectional observational study was performed at Colposcopic clinic of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from 9th November 2017 to 8th May 2018. Overall demographic features of 50 patients of precancerous cervical lesion show that, most of the patients belonged to the age group 30-39 years (46.0%), mean age was 32.7±10.3 years. Maximum numbers of respondents came from rural area (58.0%), followed by urban area (42.0%). Among them house wife- 46.0%, daily worker- 30.0% and illiterate 36.0%, primary level of education 32.6%. Among the patients the poor class 46.0% and 58.0% of the respondents were married at age ≤19 year. Among the respondents, (26.0%) were conceived their first child 1 month after their marriage and 54.0% of the women within 12 months of marriage. In this study multipara were (62.0%). Oral contraceptive pill was taken by (42.0%) of patients. The association of risk factors revealed that betel or tobacco chewing present in 28.0% cases; history of menstrual regulation (MR), dilatation, evacuation and curettage (DE&C), miscarriage were in 26.0% cases, family history of cancer were in 16.0% cases and multiple sexual exposure was in 10.0% cases. Women develop pre-malignant cervical lesions require early treatment. It is recommended that provision of proper health care support, early detection of CIN and proper management, can reduce the fatal outcome of the disease.

Clinical Indications of Cultured Epithelial Autografts

ABSTRACT

Cultured epithelial autografts (CEAs) have been used for decades as a treatment for massive burn injuries. Cultured epithelial autografts allow for wounds to heal by taking a small sample and growing a patient's own epithelium in culture to create large, graftable sheets. This technique is especially useful in large wounds where donor sites are limited compared with conventional skin grafting. However, CEAs have a variety of uses in wound healing and reconstruction and have the potential to aid in the closure of several types of defects. Cultured epithelial autografts have shown applicability in large burns, chronic nonhealing wounds, ulcerating wounds of various etiologies, congenital defects, wounds requiring specialized epithelium to replace like by like, and wounds in critically ill patients. Several factors must be considered when using CEAs, such as time, cost, and outcomes. In this article, we detail the various clinical applications of CEAs and how they can be situationally advantageous outside of their original purpose.

Relaparotomy after Cesarean Section: Experience in a Tertiary Referral Hospital

This study was aimed at exploring the causes of relaparotomy following caesarean section. The surgical procedures performed during relaparotomy were also discussed. This was a prospective study conducted in the Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from November 2020 to May 2021. MMCH is the largest referral Hospital in Mymensingh. During this study period 48 puerpera needed relaparotomy after caesarean section within 6 weeks of caesarean section. The frequency of relaparotomy was 2.6%. Of the 48 cases, 28(58.33%) cases needed relaparotomy due to post partum haemorrhage (PPH). Among them 9(18.75%) had primary PPH, 19(39.58%) patients had secondary PPH. Here 7(14.58%) patients suffered from sub rectus hematoma, 5(10.42%) patients had puerperal sepsis, 3(6.23%) had internal haemorrhage and 4(8.33%) women had wound dehiscence. Foreign body was removed in 1 case (2.08%). Main procedure performed was subtotal (45.83%) and total hysterectomy (25%). Coagulation failure and septicaemia were causes of maternal death. Case fatality rate was 4.17%. Obstetric patients who need relaparotomy face potential death. This study will help us to identify the causes for relaparotomy. Due precautions should be taken as far as possible to avoid this complications following caesarean section and thereby reduce maternal mortality and morbidity.

Full factorial design of experiment-based and response surface methodology approach for evaluating variation in uniaxial compressive mechanical properties, and biocompatibility of photocurable PEGDMA-based scaffolds

The goal of this study is to fabricate biocompatible and minimally invasive bone tissue engineering scaffolds that allowin situphotocuring and further investigate the effect on the mechanical properties of the scaffold due to the prevailing conditions around defect sites, such as the shift in pH from the physiological environment and swelling due to accumulation of fluids during inflammation. A novel approach of incorporating a general full factorial design of experiment (DOE) model to study the effect of the local environment of the tissue defect on the mechanical properties of these injectable and photocurable scaffolds has been formulated. Moreover, the cross-interaction between factors, such as pH and immersion time, was studied as an effect on the response variable. This study encompasses the fabrication and uniaxial mechanical testing of polyethylene glycol dimethacrylate (PEGDMA) scaffolds for injectable tissue engineering applications, along with the loss in weight of the scaffolds over 72 h in a varying pH environment that mimicsin vivoconditions around a defect. The DOE model was constructed with three factors: the combination of PEGDMA and nano-hydroxyapatite referred to as biopolymer blend, the pH of the buffer solution used for immersing the scaffolds, and the immersion time of the scaffolds in the buffer solution. The response variables recorded were compressive modulus, compressive strength, and the weight loss of the scaffolds over 72 h of immersion in phosphate-buffered saline at respective pH. The statistical model analysis provided adequate information in explaining a strong interaction of the factors on the response variables. Further, it revealed a significant cross-interaction between the factors. The factors such as the biopolymer blend and pH of the buffer solution significantly affected the response variables, compressive modulus and strength. At the same time, the immersion time had a strong effect on the loss in weight from the scaffolds over 72 h of soaking in the buffer solution. The biocompatibility study done using a set of fluorescent dyes for these tissue scaffolds highlighted an enhancement in the pre-osteoblasts (OB-6) cell attachment over time up to day 14. The representative fluorescent images revealed an increase in cell attachment activity over time. This study has opened a new horizon in optimizing the factors represented in the DOE model for tunable PEGDMA-based injectable scaffold systems with enhanced bioactivity.

Comparison of Risk Factors and Angiographic Profile between Younger and Older Patients with Acute Myocardial Infarction

Acute myocardial infarction (AMI) in younger adults (≤40 years) is being increasingly encountered in recent years among the South Asian population. Data regarding the presentation, risk factors and angiographic findings on this important subset of patients is lacking in our country. The aim of this study was to compare the risk factors and pattern of Coronary artery involvement in younger patients presenting with AMI with that of the older age group. This was a cross-sectional observational study conducted during the period from October 2018 to June 2019. Seventy consecutive AMI patients age ≤40 years and another 70 consecutive AMI patients age >40 years undergoing Coronary Angiogram (CAG) were included in the study. After taking informed written consent; demographic, anthropometric, risk factors, CAG findings were recorded in a pre-designed case record form. The severity of Coronary Artery Disease (CAD) was calculated by using Gensini score. The mean age of the younger and older patient groups was 36.89±4.4 years and 57.00±8.4 years respectively. Among the risk factors, smoking (67.1% versus 45.7%, p=0.017), positive family history CAD (38.6% versus 22.9%, p=0.040) and obesity (34.3% versus 20.0%, p= 0.05) were more common in younger group. Whereas, Hypertension (41.4% versus 72.9%, p=0.010) and DM (28.6% versus 50.0%, p=0.024) were more common in older patients. Younger patients mainly presented with STEMI (60.0% versus 48.6%) and predominantly had single vessel disease (42.9%), whereas older patients readily presented with NSTEMI (51.4%) and had a higher incidence of double vessel disease (32.9%) and triple vessel disease (30.0%). The Median Gensini score was significantly higher among the older patients than in the younger age group. Patients in younger age group showed a different pattern of risk factors and coronary artery involvement in comparison to the older age group. Thus, offering younger individuals to make them aware of these risk factors and their early detection, as well as an effective intervention may help to prevent AMI in younger people.

Perspectives on metal induced crystallization of a-Si and a-Ge thin films

In recent times, the metal induced crystallization (MIC) process in amorphous semiconductors (a-Si and a-Ge) has been extensively investigated by many researchers due to potential applications of crystalline semiconductors in high-density data storage devices, flat panel displays, and high performance solar cells. In this context, we have presented a review on different schemes of MIC in metal/a-Si and metal/a-Ge bilayer films (with stacking change) on various substrates under different annealing conditions. The parameters, which limit crystallization of a-Si and a-Ge have been analyzed and discussed extensively keeping in mind their applications in solar cells and flat panel displays. The MIC of a-Si and a-Ge films under ion beam irradiation has also been discussed in detail. At the end, some suggestions to overcome the limitations of the MIC process in producing better crystalline semiconductors have been proposed. We believe that this review article will inspire readers to perform a thorough investigation on various aspects of MIC for further development of high efficiency solar cells and high quality flat panel displays.

Proportion of Risk Factors among Women Attending Antenatal Checkup Unit of A Tertiary Level Hospital of Bangladesh

Women constitute a large population group in any country and they are the vulnerable or special risk group. The risk is associated with child-bearing. The purpose of antenatal care is to detect early the high risk cases from a large group of antenatal women and to arrange special skilled care for them. Aim of this cross sectional descriptive type of observational study was to find out the proportion of risk factors among women attending antenatal checkup unit of a tertiary level hospital and carried out in the antenatal checkup unit of Model Family Planning Clinic of Mymensingh Medical College Hospital, Bangladesh from January 2022 to June 2022. Data were collected from purposively selected 403 women seeking antenatal care by face to face interview, clinical examination and necessary laboratory investigations. Data were analyzed by using SPSS version 26.0. More than three forth (320, 79.4%) of the respondents were in the age group of less than 30 years and the remaining (83, 20.6%) were in the age group of 30 years and over. Mean age of the pregnant women was 24.7 years with a standard deviation of 4.7 years. Most of the pregnant women were housewives (350, 86.8%); 41(10.2%) were students and 12(3.0%) were service holders. Among the respondents rural women (254, 63.0%) were more than urban women (149, 37.0%). Seventy seven (19.1%) respondents were interviewed during 1st trimester; 140(34.7%) during 2nd semester and 186(46.2%) during 3rd semester. It was found that 12 (3.0%) women were elderly primi and 6(1.5%) were short statured primi. Eighteen (4.5%) pregnant women had malpresentations- 17(94.4%) had breech presentation and 1(5.6%) had transverse lie. Each 18(4.5%) had threatened abortion and antepartum haemorrhage. Pre-eclampsia was found in 4(1.0%) and anaemia in 14 (3.5%); twin pregnancy was found in 4 (1.0%) and hydramnios in 9(2.2%) pregnant women. Thirty one (7.7%) women had previous history of either still birth or intrauterine death or manual removal of placenta. One (0.2%) pregnant women was categorized as elderly grand multiparas. Prolonged pregnancy was found in 4(1.0%) women and 76(18.9%) women had the history of previous caesarean or instrumental delivery. Nine (2.2%) pregnant women had general diseases along with pregnancy- 5(55.6%) had asthma, 3(33.3%) had diabetes mellitus and 1(11.1%) had cardiovascular disease. Four (1.0%) women got pregnant after treatment for infertility and 2 (0.5%) women had history of three or more spontaneous consecutive abortions. Finally all the pregnant women under study were categorized on the basis of criteria of "high risk cases" and 97(24.1%) women had high risk pregnancy and the remaining 306 (75.9%) had normal pregnancy. Proportion of women with high risk pregnancy in this study is 24.1% who needs special attention and skilled care in addition to continuing better Maternal and Child Health (MCH) services for all pregnant women.

Study of Carrier Mobilities in 4H-SiC MOSFETS Using Hall Analysis

The channel conduction in 4H-SiC metal-oxide-semiconductor field effect transistors (MOSFETs) are highly impacted by charge trapping and scattering at the interface. Even though nitridation reduces the interface trap density, scattering still plays a crucial role in increasing the channel resistance in these transistors. In this work, the dominant scattering mechanisms are distinguished for inversion layer electrons and holes using temperature and body-bias-dependent Hall measurements on nitrided lateral 4H-SiC MOSFETs. The effect of the transverse electric field (Eeff) on carrier mobility is analyzed under strong inversion condition where surface roughness scattering becomes prevalent. Power law dependencies of the electron and hole Hall mobility for surface roughness scattering are determined to be Eeff-1.8 and Eeff-2.4, respectively, analogous to those of silicon MOSFETs. Moreover, for n-channel MOSFETs, the effect of phonon scattering is observed at zero body bias, whereas in p-channel MOSFETs, it is observed only under negative body biases. Along with the identification of regimes governed by different scattering mechanisms, these results highlight the importance of the selection of substrate doping and of Eeff in controlling the value of channel mobility in 4H-SiC MOSFETs.

The effects of systemic immunomodulatory treatments on COVID-19 outcomes in patients with atopic dermatitis: Results from the global SECURE-AD registry

BACKGROUND

Limited data are available on the effects of systemic immunomodulatory treatments on COVID-19 outcomes in patients with atopic dermatitis (AD).

OBJECTIVE

To investigate COVID-19 outcomes in patients with AD treated with or without systemic immunomodulatory treatments, using a global registry platform.

METHODS

Clinicians were encouraged to report cases of COVID-19 in their patients with AD in the Surveillance Epidemiology of Coronavirus Under Research Exclusion for Atopic Dermatitis (SECURE-AD) registry. Data entered from 1 April 2020 to 31 October 2021 were analysed using multivariable logistic regression. The primary outcome was hospitalization from COVID-19, according to AD treatment groups.

RESULTS

442 AD patients (mean age 35.9 years, 51.8% male) from 27 countries with strongly suspected or confirmed COVID-19 were included in analyses. 428 (96.8%) patients were treated with a single systemic therapy (n = 297 [67.2%]) or topical therapy only (n = 131 [29.6%]). Most patients treated with systemic therapies received dupilumab (n = 216). Fourteen patients (3.2%) received a combination of systemic therapies. Twenty-six patients (5.9%) were hospitalized. No deaths were reported. Patients treated with topical treatments had significantly higher odds of hospitalization, compared with those treated with dupilumab monotherapy (odds ratio (OR) 4.65 [95%CI 1.71-14.78]), including after adjustment for confounding variables (adjusted OR (aOR) 4.99 [95%CI 1.4-20.84]). Combination systemic therapy which did not include systemic corticosteroids was associated with increased odds of hospitalization, compared with single agent non-steroidal immunosuppressive systemic treatment (OR 8.09 [95%CI 0.4-59.96], aOR 37.57 [95%CI 1.05-871.11]). Hospitalization was most likely in patients treated with combination systemic therapy which included systemic corticosteroids (OR 40.43 [95%CI 8.16-207.49], aOR 45.75 [95%CI 4.54-616.22]).

CONCLUSIONS

Overall, the risk of COVID-19 complications appears low in patients with AD, even when treated with systemic immunomodulatory agents. Dupilumab monotherapy was associated with lower hospitalization than other therapies. Combination systemic treatment, particularly combinations including systemic corticosteroids, was associated with the highest risk of severe COVID-19.

Outbreak of Ichthyophthirius multifiliis associated with Aeromonas hydrophila in Pangasianodon hypophthalmus: The role of turmeric oil in enhancing immunity and inducing resistance against co-infection

Ichthyophthirius multifiliis, a ciliated parasite causing ichthyophthiriasis (white spot disease) in freshwater fishes, results in significant economic loss to the aquaculture sector. One of the important predisposing factors for ichthyophthiriasis is low water temperature (i.e., below 20°C), which affects the health and makes freshwater fishes more susceptible to parasitic infections. During ichthyophthiriasis, fishes are stressed and acute immune reactions are compromised, which enables the aquatic bacterial pathogens to simultaneously infect the host and increase the severity of disease. In the present work, we aimed to understand the parasite–bacteria co-infection mechanism in fish. Later, Curcuma longa (turmeric) essential oil was used as a promising management strategy to improve immunity and control co-infections in fish. A natural outbreak of I. multifiliis was reported (validated by 16S rRNA PCR and sequencing method) in Pangasianodon hypophthalmus from a culture facility of ICAR-CIFRI, India. The fish showed clinical signs including hemorrhage, ulcer, discoloration, and redness in the body surface. Further microbiological analysis revealed that Aeromonas hydrophila was associated (validated by 16S rRNA PCR and sequencing method) with the infection and mortality of P. hypophthalmus, confirmed by hemolysin and survival assay. This created a scenario of co-infections, where both infectious agents are active together, causing ichthyophthiriasis and motile Aeromonas septicemia (MAS) in P. hypophthalmus. Interestingly, turmeric oil supplementation induced protective immunity in P. hypophthalmus against the co-infection condition. The study showed that P. hypophthalmus fingerlings supplemented with turmeric oil, at an optimum concentration (10 ppm), exhibited significantly increased survival against co-infection. The optimum concentration induced anti-stress and antioxidative response in fingerlings, marked by a significant decrease in cortisol and elevated levels of superoxide dismutase (SOD) and catalase (CAT) in treated animals as compared with the controls. Furthermore, the study indicated that supplementation of turmeric oil increases both non-specific and specific immune response, and significantly higher values of immune genes (interleukin-1β, transferrin, and C3), HSP70, HSP90, and IgM were observed in P. hypophthalmus treatment groups. Our findings suggest that C. longa (turmeric) oil modulates stress, antioxidant, and immunological responses, probably contributing to enhanced protection in P. hypophthalmus. Hence, the application of turmeric oil treatment in aquaculture might become a management strategy to control co-infections in fishes. However, this hypothesis needs further validation.

Pattern of Fetal Congenital Anomalies and Its Relation with Maternal Factors

Congenital anomalies are one of the four leading causes of neonatal mortality in Bangladesh. The risk factors which are predictive of congenital anomaly in babies vary from country to country. In a developing country like Bangladesh many possible factors are present which should be identified & frequency needs to be assessed to understand the burden. The aim of this study was to determine the patterns and related maternal factors of fetal congenital anomaly. This cross-sectional type of comparative study was conducted at Department of Obstetrics & Gynecology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from September 2019 to August 2020. All the births occurring in the labor room were recorded. All newborn babies born with congenital anomalies were identified & included in this study. The rate of congenital anomalies was estimated and common types of congenital anomalies were noted. This study was conducted involving all women who had babies with congenital anomalies and the same number whose babies had no congenital anomalies. A structured questionnaire was used during data collection. Data was analyzed by Chi square test, bivariate analysis & multivariate logistic regression using statistical package for social sciences (SPSS) version 26.0. During the study period, 11479 deliveries were conducted. Among them 87 cases with congenital anomalies were identified. Frequency of congenital anomaly was 0.8%. Central nervous system was the predominant system involved (49.4%). Regarding risk assessment, Maternal age >30 years (OR 2.96, 95% CI 1.10-7.93, p value 0.032), consanguinity (OR 7.73, 95% CI 1.79-33.39, p value 0.006), first degree relative with history of congenital anomaly (OR 35.52, 95% CI 4.31-292.86, p value 0.001) and no intake of folic acid (OR 15.99, 95% CI 5.28-48.52, p value <0.001), passive smoking (OR 6.45, 95% CI 1.66-25.09, p value 0.007) were independent risk factors for congenital anomalies.

Mechano-Immunomodulation in Space: Mechanisms Involving Microgravity-Induced Changes in T Cells

Of the most prevalent issues surrounding long-term spaceflight, the sustainability of human life and the maintenance of homeostasis in an extreme environment are of utmost concern. It has been observed that the human immune system is dysregulated in space as a result of gravitational unloading at the cellular level, leading to potential complications in astronaut health. A plethora of studies demonstrate intracellular changes that occur due to microgravity; however, these ultimately fall short of identifying the underlying mechanisms and dysfunctions that cause such changes. This comprehensive review covers the changes in human adaptive immunity due to microgravity. Specifically, there is a focus on uncovering the gravisensitive steps in T cell signaling pathways. Changes in gravitational force may lead to interrupted immune signaling cascades at specific junctions, particularly membrane and surface receptor-proximal molecules. Holistically studying the interplay of signaling with morphological changes in cytoskeleton and other cell components may yield answers to what in the T cell specifically experiences the consequences of microgravity. Fully understanding the nature of this problem is essential in order to develop proper countermeasures before long-term space flight is conducted.

Electron beam-induced crystallization of Al2O3 gate layer on β-Ga2O3 MOS capacitors

Electron irradiation was observed to induce crystallization of amorphous Al₂O₃ films grown by atomic layer deposition on β-Ga₂O₃ substrates. Growth of large, strongly oriented crystalline γ-Al₂O₃ regions was induced using conventional-mode transmission electron microscopy (TEM) and observed to propagate outward from the interface as well as from the previously crystallized Al₂O₃. A few nm of epitaxial Al₂O₃ was already visible at the beginning of the crystallization front propagation. The phenomenon is not explained by electron beam-induced heating, which amounted to less than 1 K at all times. Direct measurement of the beam current permitted quantitative correlation between electron dose rates and crystallization rates. Enlarging the electron beam to reduce current density was found to slow the propagation of the crystallization front. Furthermore, a factor of 4 smaller electron dose was required for a given rate using 100 keV electrons as compared to 200 keV, indicating that crystallization is driven by ionization-induced atomic rearrangement within the gate layer. Lattice spacing between the oxygen sub-lattices of β-Ga₂O₃ and γ-Al₂O₃ are favorable for the nucleation of crystallites at the interface. Multivariate statistical analysis of electron energy loss spectroscopy (EELS) data also showed evidence of diffusion between Al and Ga in the substrates and gate oxides, respectively. These structural transformations at the semiconductor-insulator interface are expected to influence the device electrical behavior and are relevant to the continued refinement of β-Ga₂O₃ device technology.

Predictive Value of Waist Height Ratio, Waist Hip Ratio and Body Mass Index in Assessing Angiographic Severity of Coronary Artery Disease in Myocardial Infarction Patients

Coronary artery disease (CAD) is the leading cause of mortality and morbidity both in developed and developing countries. The body mass index (BMI), waist hip ratio (WHR) and waist height ratio (WHtR) are some of the clinical tools enabling clinicians to assess obesity. Although for decades there have been controversy regarding the relationship between obesity and CAD; it has been assumed that high BMI is a risk factor for CAD. However, the findings of some recent studies were paradoxical. The aim of this study was to identify the best tool among BMI, WHtR and WHR to evaluate angiographically severe CAD in myocardial infarction patients. This was a cross-sectional analytical study carried out in the Department of Cardiology, Chattogram Medical College and Hospital (CMCH), Chattogram, Bangladesh from January 2017 to December 2017. Three hundred and thirty two consecutive MI patients undergoing CAG during the study period were included in the study as per inclusion and exclusion criteria. Severity of CAD was calculated by using Gensini score. Patients were categorized and compared according to anthropometric indices and CAD severity. The mean±SD of the age of study population was 53.62±10.36 years (range 25-92) and 276(83.1%) were male. Regarding cardiovascular risk factors, 113(34%) patients had diabetes mellitus, 108(32.5%) had dyslipidaemia, 137(41.3%) had hypertension, 205(61.7%) were current or ex-smokers and 59(17.8%) had a family history of CAD. The mean±SD of the patients' BMI was 24.05±3.24kg/m² (range 16.14-32.72), mean±SD of their WHR was 0.964±0.052 (range 0.823-1.125) and mean±SD of their WHtR was 0.546±0.059 (range 0.389-0.748). The mean±SD of the severity of CAD according to the Gensini score was 41.11±28.66 (ranged from 2 to 244). Study findings showed a positive correlation between the severity of CAD with WHtR and WHR but not with BMI, according to Gensini scores (p=0.004, p=0.023 and p=0.43 respectively). Receiver Operating Characteristics (ROC) curve analysis revealed that waist height ratio had the highest area under the curve (AUC) among the three anthropometric parameters for predicting presence of severe CAD. Study showed the superiority of WHtR over WHR and BMI for predicting angiographic severity of CAD in patients with MI. WHtR should therefore be considered as a screening tool.

Correlation of Mean Platelet Volume with ST Segment Resolution after Thrombolytic Therapy in Patients with ST Elevation Myocardial Infarction

Acute occlusive thrombosis of the coronary artery is the principal cause of myocardial infarction where platelets play an important role. Large size platelets, easily measured by mean platelets volume (MPV) are thrombogenic and commonly seen after ST-segment elevation myocardial infarction (STEMI). ST segment resolution has been shown as a simple non-invasive marker that reflects both epicardial and myocardial reperfusion following thrombolysis. The present study intended to investigate whether MPV on admission correlated with ST segment resolution following thrombolysis in STEMI patient. This cross-sectional analytical study was conducted in the department of cardiology, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh from December, 2016 to June, 2018. Total 284 patients with first attack of STEMI were included after considering inclusion and exclusion criteria. Sample population was divided into two groups, Group I - Patients with successful ST segment resolution (≥50%). Group II - Patients with impaired ST segment resolution (<50%). MPV on admission was estimated during estimation of Complete Blood Count (CBC) by Automated Haematology Analyzer & compared between two groups. Successful ST segment resolution (≥50%) was seen in 67% of patients after thrombolysis. Admission MPV was higher in patients with impaired ST segment resolution (<50%) group than patients with ≥50% ST-segment resolution group (12.42±0.89fl vs.10.35±0.77fl respectively, p=0.001). Statistically significant strong negative correlation between MPV and ST segment resolution percentage (r = -0.742, p=0.001) suggesting that the higher the level of MPV, the lower the ST segment resolution percentage in first attack of STEMI patients. Multivariate regression analysis found MPV level on admission as an independent predictor of ST segment resolution. The study concluded that high MPV on admission correlate with impaired ST segment resolution following thrombolysis in STEMI patients.

An assessment on crystallization phenomena of Si in Al/a-Si thin films via thermal annealing and ion irradiation

In the present study, crystallization of amorphous-Si (a-Si) in Al/a-Si bilayer thin films under thermal annealing and ion irradiation has been investigated for future solar energy materials applications. In particular, the effect of thickness ratio (e.g. in Al : a-Si, the ratio of the Al and a-Si layer thickness) and temperature during irradiation on crystallization of the Si films has been explored for the first time. Two sets of samples with thickness ratio 1 : 1 (set-A: 50 nm Al/50 nm a-Si) and thickness ratio 1 : 3 (set-B: 50 nm Al/150 nm a-Si) have been prepared on thermally oxidized Si-substrates. In one experiment, thermal annealing of the as-prepared sample (of both the sets) has been done at different temperatures of 100 °C, 200 °C, 300 °C, 400 °C, and 500 °C. Significant crystallization was found to initiate at 200 °C with the help of thermal annealing, which increased further by increasing the temperature. In another experiment, ion irradiation on both sets of samples has been carried out at 100 °C and 200 °C using 100 MeV Ni7+ ions with fluences of 1 × 1012 ions per cm2, 5 × 1012 ions per cm2, 1 × 1013 ions per cm2, and 5 × 1013 ions per cm2. Significant crystallization of Si was observed at a remarkably low temperature of 100 °C under ion irradiation. The samples irradiated at 100 °C show better crystallization than the samples irradiated at 200 °C. The maximum crystallization of a-Si has been observed at a fluence of 1 × 1012 ions per cm2, which was found to decrease with increasing ion fluence at both temperatures (i.e. 100 °C & 200 °C). The crystallization of a-Si is found to be better for set-B samples as compared to set-A samples at all the fluences and irradiation temperatures. The present work is aimed at developing the understanding of the crystallization process, which may have significant advantages for designing crystalline layers at lower temperature using appropriate masks for irradiation at the desired location. The detailed mechanisms behind all the above observations are discussed in this paper.

Crystallization of Ge in ion-irradiated amorphous-Ge/Au thin films

Herein, the structural, optical, and electrical properties of Au-induced crystallization in amorphous germanium (a-Ge) thin films are presented for future solar energy material applications.

The role of bacterial skin infections in atopic dermatitis: expert statement and review from the International Eczema Council Skin Infection Group

Patients with atopic dermatitis (AD) have an increased risk of bacterial skin infections, which cause significant morbidity and, if untreated, may become systemic. Staphylococcus aureus colonizes the skin of most patients with AD and is the most common organism to cause infections. Overt bacterial infection is easily recognized by the appearance of weeping lesions, honey‐coloured crusts and pustules. However, the wide variability in clinical presentation of bacterial infection in AD and the inherent features of AD – cutaneous erythema and warmth, oozing associated with oedema, and regional lymphadenopathy – overlap with those of infection, making clinical diagnosis challenging. Furthermore, some features may be masked because of anatomical site‐ and skin‐type‐specific features, and the high frequency of S. aureus colonization in AD makes positive skin swab culture of suspected infection unreliable as a diagnostic tool. The host mechanisms and microbial virulence factors that underlie S. aureus colonization and infection in AD are incompletely understood. The aim of this article is to present the latest evidence from animal and human studies, including recent microbiome research, to define the clinical features of bacterial infections in AD, and to summarize our current understanding of the host and bacterial factors that influence microbial colonization and virulence.

Thermal characterization of gallium oxide Schottky barrier diodes

The higher critical electric field of β-gallium oxide (Ga₂O₃) gives promise to the development of next generation power electronic devices with improved size, weight, power, and efficiency over current state-of-the-art wide bandgap devices based on 4H-silicon carbide (SiC) and gallium nitride (GaN). However, it is expected that Ga₂O₃ devices will encounter serious thermal issues due to the poor thermal conductivity of the material. In this work, self-heating in Ga₂O₃ Schottky barrier diodes under different regimes of the diode operation was investigated using diverse optical thermography techniques including thermoreflectance thermal imaging, micro-Raman thermography, and infrared thermal microscopy. 3D coupled electro-thermal modeling was used to validate experimental results and to understand the mechanism of heat generation for the diode structures. Measured top-side and cross-sectional temperature fields suggest that device and circuit engineers should account for the concentrated heat generation that occurs near the anode/Ga₂O₃ interface and/or the lightly doped drift layer under both forward and high voltage reverse bias conditions. Results of this study suggest that electro-thermal co-design techniques and top-side thermal management solutions are necessary to exploit the full potential of the Ga₂O₃ material system.

Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement

BACKGROUND

Guidelines discourage the use of systemic corticosteroids for atopic dermatitis (AD), but their use remains widespread.

OBJECTIVES

To reach consensus among an international group of AD experts on the use of systemic corticosteroids for AD.

METHODS

A survey consisting of statements accompanied by visual analogue scales ranging from 'strongly disagree' to 'neutral' to 'strongly agree' was distributed to the International Eczema Council (IEC). Consensus was reached in agreement on a statement if < 30% of respondents marked to the left of 'neutral' towards 'strongly disagree'.

RESULTS

Sixty of 77 (78%) IEC members participated. Consensus was reached on 12 statements, including that systemic corticosteroids should generally be avoided but can be used rarely for severe AD under certain circumstances, including a lack of other treatment options, as a bridge to other systemic therapies or phototherapy, during acute flares in need of immediate relief, in anticipation of a major life event or in the most severe cases. If used, treatment should be limited to the short term. Most respondents agreed that systemic corticosteroids should never be used in children, but consensus was not reached on that statement. The conclusions of our expert group are limited by a dearth of high-quality published evidence. If more stringent consensus criteria were applied (e.g. requiring < 20% of respondents marking towards 'strongly disagree'), consensus would have been reached on fewer statements.

CONCLUSIONS

Based on expert opinion from the IEC, routine use of systemic corticosteroids for AD is generally discouraged and should be reserved for special circumstances.

Exciton Emission Intensity Modulation of Monolayer MoS2 via Au Plasmon Coupling

Modulation of photoluminescence of atomically thin transition metal dichalcogenide two-dimensional materials is critical for their integration in optoelectronic and photonic device applications. By coupling with different plasmonic array geometries, we have shown that the photoluminescence intensity can be enhanced and quenched in comparison with pristine monolayer MoS2. The enhanced exciton emission intensity can be further tuned by varying the angle of polarized incident excitation. Through controlled variation of the structural parameters of the plasmonic array in our experiment, we demonstrate modulation of the photoluminescence intensity from nearly fourfold quenching to approximately threefold enhancement. Our data indicates that the plasmonic resonance couples to optical fields at both, excitation and emission bands, and increases the spontaneous emission rate in a double spacing plasmonic array structure as compared with an equal spacing array structure. Furthermore our experimental results are supported by numerical as well as full electromagnetic wave simulations. This study can facilitate the incorporation of plasmon-enhanced transition metal dichalcogenide structures in photodetector, sensor and light emitter applications.

Polarization induced two dimensional confinement of carriers in wedge shaped polar semiconductors

A novel route to achieve two dimensional (2D) carrier confinement in a wedge shaped wall structure made of a polar semiconductor has been demonstrated theoretically. Tapering of the wall along the direction of the spontaneous polarization leads to the development of charges of equal polarity on the two inclined facades of the wall. Polarization induced negative (positive) charges on the facades can push the electrons (holes) inward for a n-type (p-type) material which results in the formation of a 2D electron (hole) gas at the central plane and ionized donors (acceptors) at the outer edges of the wall. The theory shows that this unique mode of 2D carrier confinement can indeed lead to a significant enhancement of carrier mobility. It has been found that the reduced dimensionality is not the only cause for the enhancement of mobility in this case. Ionized impurity scattering, which is one of the major contributer to carrier scattering, is significantly suppressed as the carriers are naturally separated from the ionized centers. A recent experimental finding of very high electron mobility in wedge shaped GaN nanowall networks has been analyzed in the light of this theoretical reckoning.

Tuning the threshold voltage from depletion to enhancement mode in a multilayer MoS2 transistor via oxygen adsorption and desorption

In this work, a simple method based on low-temperature annealing in air is developed for effective chemical doping in MoS₂. The threshold voltage of multilayer MoS₂ FET can be effectively tuned from depletion mode (Vth = ¬1.8 V) to enhancement mode (Vth = 1.1 V) by annealing in air at 150 °C.

Unexpected observation of spatially separated Kondo scattering and ferromagnetism in Ta alloyed anatase TiO2 thin films

We report the observation of spatially separated Kondo scattering and ferromagnetism in anatase Ta_0.06Ti_0.94O₂ thin films as a function of thickness (10–200 nm). The Kondo behavior observed in thicker films is suppressed on decreasing thickness and vanishes below ~25 nm. In 200 nm film, transport data could be fitted to a renormalization group theory for Kondo scattering though the carrier density in this system is lower by two orders of magnitude, the magnetic entity concentration is larger by a similar magnitude and there is strong electronic correlation compared to a conventional system such as Cu with magnetic impurities. However, ferromagnetism is observed at all thicknesses with magnetic moment per unit thickness decreasing beyond 10 nm film thickness. The simultaneous presence of Kondo and ferromagnetism is explained by the spatial variation of defects from the interface to surface which results in a dominantly ferromagnetic region closer to substrate-film interface while the Kondo scattering is dominant near the surface and decreasing towards the interface. This material system enables us to study the effect of neighboring presence of two competing magnetic phenomena and the possibility for tuning them.

Obstetric Outcome in Early and Late Onset Gestational Diabetes Mellitus

Obstetric outcome in early onset and late onset GDM was compared in a prospective study conducted at the Department of Obstetrics & Gynecology in BIRDEM, Dhaka, Bangladesh. A total 120 pregnant women were recruited purposively for the study in which 60 were early onset GDM and 60 were late onset GDM during study period of January 2008 to December 2009. Patients were followed up in different periods of gestation, during delivery and early postpartum period & findings were compared between two groups. BMI & family history of diabetes were significantly higher in early GDM group (p<0.05). Evidence of increased glycaemia was observed in early GDM group & difference of glycaemic status was statistically significant (p<0.05). Insulin was needed in 85% of early onset GDM and 55% in late onset GDM. There was also significant difference (p<0.05). In this study, 23.3% of early onset GDM group developed pre-eclampsia while in late onset GDM it was 10% and was statistically significant (p<0.05). Regarding intrapartum & postpartum complications - perineal tear, PPH wound infection, puerperal sepsis were more in early onset than late onset GDM group with no significant difference. Regarding foetal outcome, 8.3% early GDM group delivered asphyxiated baby in comparison to 3.3% in late GDM group. Twenty percent (20%) of early onset GDM group had to admit their babies in neonatal unit while in late onset group it was 5%. There was significant difference between two groups (p<0.05). Neonatal hypoglycaemia was also statistically significantly (p<0.05) higher in early GDM group. Neonatal hyper-bilirubinaemia, RDS, perinatal death was more in early onset GDM subjects. Early onset GDM subjects are high risk subgroup & have significant deleterious effect on maternal and perinatal outcome than late GDM groups.

Open Reduction and Internal Fixation of displaced Supracondylar Fractures of Humerus with Crossed K-wires via Medial Approach

This study aimed at evaluating the medial approach for open reduction and internal fixation of Gartland type 3 displaced supracondylar fractures of humerus in children. A prospective, single centre study of on displaced supracondylar humerus fractures in 42 children was carried out at our institute. All fractures were managed with open reduction and internal fixation with crossed K-wires via medial approach. The mean follow-up was 12 months and patients were assessed according to Flynn’s criteria. No patients had post-operative ulnar nerve injury. Cubitus varus was not seen in any patient. Superficial pin tract infection occurred in three patients that subsided with anti-septic dressings and antibiotics. No deep infection occurred. 88.09 % patients showed satisfactory results as per Flynn’s criteria. The medial approach provides an excellent view of the supracondylar area. The approach is convenient due to a lower risk for ulnar nerve injury and better acceptability of the medial incisional scar.

Endoscopic ultrasound of the colon for the differentiation of Crohn's disease and ulcerative colitis in comparison with healthy controls

BACKGROUND

Diagnosis of inflammatory bowel disease (IBD) is based on clinical presentation, colonoscopy and histology. Differentiation of Crohn's disease (CD) and ulcerative colitis (UC) can be difficult in some patients. Endoscopic ultrasound (EUS) provides high resolution images of the gastrointestinal wall (GI) and may be an alternative to differentiate CD/UC.

AIM

EUS of the GI layers in patients with IBD and healthy controls (HC) for the differential diagnosis of UC/CD in a prospective, blinded study.

METHODS

Consecutive patients with CD, UC or HC underwent EUS in the mid sigmoid colon with a forward-viewing radial echoendoscope. Mucosal, submucosal, total wall thickness (TWT) and locoregional lymphnodes (LN) were assessed by EUS in a blinded fashion. TWT was correlated with macroscopic IBD scores and histological inflammation scores.

RESULTS

Total wall thickness of 61 HC was 1.71 ± 0.02 mm, and 3.51 ± 0.15 mm in n = 52 with active IBD. In patients with active UC significant thickening of the mucosa was observed but nearly normal submucosa and m.propria. In active CD significant thickening of the submucosal layer was seen with nearly normal mucosa and m.propria [MucosaUC  = 2.08 ± 0.11 mm, MucosaCD  = 1.32 ± 0.17 mm (P = 0.0001); SubmucosaUC  = 1.01 ± 0.08 mm, SubmucosaCD  = 2.01 ± 0.22 mm (P = 0.0001)]. In 73.7% of patients with active CD, but in none with UC, paracolonic lymph nodes were detected. When mucosal-submucosal and TWT and LNs were combined, the sensitivity was 92.3% for the differentiation of active UC/CD. There was a strong correlation of TWT with histological inflammation scores (UC: r = 0.43; CD: r = 0.69).

CONCLUSIONS

Increased total wall thickness has a high positive predictive value for active IBD. EUS can differentiate active UC from CD and quantify the level of colonic inflammation.

Anisotropic two-dimensional electron gas at the LaAlO₃/SrTiO₃ (110) interface

The observation of a high-mobility two-dimensional electron gas between two insulating complex oxides, especially LaAlO₃/SrTiO₃, has enhanced the potential of oxides for electronics. The occurrence of this conductivity is believed to be driven by polarization discontinuity, leading to an electronic reconstruction. In this scenario, the crystal orientation has an important role and no conductivity would be expected, for example, for the interface between LaAlO₃ and (110)-oriented SrTiO₃, which should not have a polarization discontinuity. Here we report the observation of unexpected conductivity at the LaAlO₃/SrTiO₃ interface prepared on (110)-oriented SrTiO₃, with a LaAlO₃-layer thickness-dependent metal-insulator transition. Density functional theory calculation reveals that electronic reconstruction, and thus conductivity, is still possible at this (110) interface by considering the energetically favourable (110) interface structure, that is, buckled TiO₂/LaO, in which the polarization discontinuity is still present. The conductivity was further found to be strongly anisotropic along the different crystallographic directions with potential for anisotropic superconductivity and magnetism, leading to possible new physics and applications.

Although LaAlO₃ and SrTiO₃ are both insulators, when they are brought together at a (100) interface, a highly conducting two-dimensional electron gas forms between them. Annandi et al. show that this also happens at a (110) interface, counter to expectations that it should not.

Endoscopic ultrasound-guided fine needle aspiration training: evaluation of a new porcine lymphadenopathy model for in vivo hands-on teaching and training, and review of the literature

BACKGROUND AND STUDY AIMS

Adequate training is required to achieve successful endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA). Of the variety of training models currently available, none offers verisimilitude to the tactile feel of puncturing a human lymph node. The aim of the current study was to evaluate a new porcine lymph node model for EUS-FNA training and to evaluate its impact on trainees' performance in patients compared with the literature of other models available.

METHODS

Two trainees each performed EUS-FNA of 96 lymph nodes in 18 animals with induced lymphadenopathy (mean 1.6 cm [range 0.9-3.5 cm]). Accuracy, speed, adequacy of sampling, and trainees' performance pre- and post-training were measured. Using a questionnaire, data were gathered regarding the effect of training and comfort level in patients. Results were compared with those in the literature.

RESULTS

Trainees progressed from hands-on assistance to occasional verbal guidance toward the end of animal training. There was good correlation between puncture time and number of EUS-FNA procedures performed in all but the subcarinal location (r = - 0.17). Comparison of trainee performance in patients before and after training showed a reduction in puncture time (P = 0.0014). Questionnaire analysis revealed increased confidence in echoendoscope- and needle-handling. Comparison with other published models supports these results.

CONCLUSION

Results from the literature and the current study showed that animal training improves trainee performance, confidence, and procedural comfort when returning to patient examinations. The new model produces a realistic response that is similar to EUS-FNA in patients; this experience provides a benefit to endoscopists in terms of improved performance in patients and could be considered for use in accreditation. Due to the small numbers of trainees, larger experiences are needed to confirm training efficacy.

Serous endometrial intraepithelial carcinoma: a case series and literature review

BACKGROUND

Minimal uterine serous cancer (MUSC) or serous endometrial intraepithelial carcinoma (EIC) has been described by many different names since 1998. There have been very few cases reported in literature since EIC/MUSC was recognized as a separate entity. The World health Organization (WHO) Classification favors the term serous EIC. Although serous EIC is confined to the uterine endometrium at initial histology diagnosis, a significant number of patients could have distal metastasis at diagnosis, without symptoms. Serous EIC is considered as being the precursor of uterine serous cancer (USC), but pure serous EIC also has an aggressive behavior similar to USC. It is therefore prudent to have an accurate diagnosis and appropriate surgical staging. There are very few published articles in literature that discuss the pure form of serous EIC. The aim of this series is to share our experience and review evidence for optimum management of serous EIC.

PATIENTS AND METHODS

We report a series of five women treated in our institute in the last 3 years. We reviewed the relevant literature on serous EIC and various management strategies, to recommend best clinical practice.

CONCLUSION

Pure serous EIC is a difficult histopathological diagnosis, which requires ancillary immunohistochemical staining. It can have an aggressive clinical behavior with early recurrence and poor survival. Optimum surgical staging, with appropriate adjuvant treatment, should be discussed when treating these patients.

Cationic-vacancy-induced room-temperature ferromagnetism in transparent, conducting anatase Ti1-xTaxO2 (x~0.05) thin films

We report room-temperature ferromagnetism (FM) in highly conducting, transparent anatase Ti(1-x)Ta(x)O(2) (x∼0.05) thin films grown by pulsed laser deposition on LaAlO(3) substrates. Rutherford backscattering spectrometry (RBS), X-ray diffraction, proton-induced X-ray emission, X-ray absorption spectroscopy (XAS) and time-of-flight secondary-ion mass spectrometry indicated negligible magnetic contaminants in the films. The presence of FM with concomitant large carrier densities was determined by a combination of superconducting quantum interference device magnetometry, electrical transport measurements, soft X-ray magnetic circular dichroism (SXMCD), XAS and optical magnetic circular dichroism, and was supported by first-principles calculations. SXMCD and XAS measurements revealed a 90 per cent contribution to FM from the Ti ions, and a 10 per cent contribution from the O ions. RBS/channelling measurements show complete Ta substitution in the Ti sites, though carrier activation was only 50 per cent at 5 per cent Ta concentration, implying compensation by cationic defects. The role of the Ti vacancy (V(Ti)) and Ti(3+) was studied via XAS and X-ray photoemission spectroscopy, respectively. It was found that, in films with strong FM, the V(Ti) signal was strong while the Ti(3+) signal was absent. We propose (in the absence of any obvious exchange mechanisms) that the localized magnetic moments, V(Ti) sites, are ferromagnetically ordered by itinerant carriers. Cationic-defect-induced magnetism is an alternative route to FM in wide-band-gap semiconducting oxides without any magnetic elements.

Gellan gum capped silver nanoparticle dispersions and hydrogels: cytotoxicity and in vitro diffusion studies

The preparation of highly stable water dispersions of silver nanoparticles using the naturally available gellan gum as a reducing and capping agent is reported. Further, exploiting the gel formation characteristic of gellan gum silver nanoparticle incorporated gels have also been prepared. The optical properties, morphology, zeta potential and long-term stability of the synthesized silver nanoparticles were investigated. The superior stability of the gellan gum-silver nanoparticle dispersions against pH variation and electrolyte addition is revealed. Finally, we studied the cytotoxicity of AgNP dispersions in mouse embryonic fibroblast cells (NIH3T3) and also evaluated the in vitro diffusion of AgNP dispersions/gels across rat skin.