Demographic and Clinical Characteristics of Persons With Spinal Cord Injury in Bangladesh: Database for the International Spinal Cord Injury Community Survey 2023

The study aims to explore the demographic and clinical characteristics of persons with spinal cord injury (SCI) in Bangladesh. A total of 3035 persons with SCI spanning from 2018 to 2022 were included in this cross-sectional study. Information about demographic and clinical variables was obtained from the medical records and verified through telephone calls to ensure accuracy and consistency. Approximately half (48.30%) of the study participants were located in Dhaka Division. The average age of persons with SCI was 38.3 years, with a standard deviation of 15.9 years, and the largest proportion (33.4%) fell within the age range of 18-30 years. Males outnumbered females by nearly 2.5 times. In the study, 59.6% had suffered traumatic injuries, whereas 40.4% had SCI attributable to disease-related causes; 58.1% were diagnosed with tetraplegia and 40.1% with paraplegia. Fall from height (42.1%) and road traffic trauma (27%) were the most common causes of traumatic injuries. Degenerative myelopathy (41.1%) was the most frequent cause of non-traumatic SCI, followed by tumors (27.7%) and tuberculosis (TB; 14.8%). Both traumatic (58.3%) and degenerative (56.7%) causes of SCI commonly affected the cervical spine, whereas TB (24.4%) and tumors (47.5%) had a higher incidence of affecting the dorsal spine. In the absence of a registry or national database for patients with SCI in Bangladesh, this study would serve as representative data for future studies.

Heat transport in inclined flow towards a rotating disk under MHD

Flow towards a rotating disk is of highly practical significance in numerous engineering applications such as Turbine disks, rotary type machine systems and many more. In light of this, the current work is an attempt to explore MHD oblique flow towards a rotating disk. Hydromagnetic effects in addition to heat transfer is taken into consideration. The flow governing Partial Differential Equations are altered to a system to coupled non-linear Ordinary Differential Equations through scaling group of transformations which afterwards are tackled using Shooting Algorithm. The impact of obliqueness parameter γ, rotation ratio parameter [Formula: see text] and magnetic field parameter M on 2-dimensional and 3-dimensional stream contours are presented. Location of the shear center varies with magnetic field parameter. Heat flow at the disk surface boosts with magnet field parameter M and rotation ratio parameter [Formula: see text].

Influence of Trichoderma harzianum and Bacillus thuringiensis with reducing rates of NPK on growth, physiology, and fruit quality of Citrus aurantifolia

Abstract Continuous use of chemical fertilizers gradually shrinks the crop yield and quality, and these adverse effects can be reduced by adopting new sustainable practices such as the use of manure, biofertilizers, and nano fertilizers. Limited information is existed on the application of Trichoderma harzianum and Bacillus thuringiensis microbes to improve lemon seedlings growth, physiology, and fruit formation. Therefore, the current study is aimed to evaluate the effects of T. harzianum and B. thuringiensis microbes mixing with low levels of inorganic fertilizer (NPK) on the plant growth, development, and quality of limau nipis (key lemon) fruits. The lemon seedlings growing media were inoculated during transplanting with T. harzianum and B. thuringiensis at various NPK fertilizers under polybagged conditions. The seedlings were grown around eighteen (18) months after inoculation with biofertilizers followed by Randomized Complete Block Design (RCBD) with five (5) replications. The results showed that T. harzianum with 50 g of NPK treatment (T2) increased the seedling's height, branch number, leaf height, ground area, and absolute growth rate (AGR) plant height by 50.12%, 107.84%, 17.91%, 17.91%, 116.93%, and 56.02%, respectively, over the control treatment. The number of leaves (60.82%), leaf area (42.75%), stem diameter (27.34%), specific leaf area (SLA) (39.07%), leaf area index (LAI) (54.40%), and absolute growth rate for leaf number (73.86%), leaf area (306.85%) and stem diameter (46.8%) of lemon seedlings increased significantly with B. thuringiensis plus 50 g NPK treatment (T3). The applications of B. thuringiensis with 25 g NPK fertilizer treatment (T5) increased leaf fresh weight (LFW), leaf dry weight (LDW), leaf moisture content (LMC), specific leaf weight (SLW), leaf relative growth rate (RGR), and chlorophyll content by 96.45%, 56.78%, 13.60%, 24.76%, 45.45%, and 16.22%, respectively, over the control group. In addition, T5 treatment increased the fruits number, individual fruit weight, fruit diameter, fruit dimension, leaf total soluble solids (TSS), and fruit TSS content of lemon tress by 81.81%, 55.52%, 43.54%, 25.69%, 89.47%, and 70.78% compared to the control treatment. Furthermore, soil inoculation of B. thuringiensis significantly increased the pulp to peel ratio and juice content of lemon fruits. From this study, it can be concluded that soil inoculation of both T. harzianum and B. thuringiensis with 25-50% NPK during transplanting improved plant growth, physiology, and fruit quality of limau nipis trees.

Incorporating non-stomatal limitation improves the performance of leaf and canopy models at high vapour pressure deficit

Vapour pressure deficit (D) is projected to increase in the future as temperature rises. In response to increased D, stomatal conductance (gs) and photosynthesis (A) are reduced, which may result in significant reductions in terrestrial carbon, water and energy fluxes. It is thus important for gas exchange models to capture the observed responses of gs and A with increasing D. We tested a series of coupled A-gs models against leaf gas exchange measurements from the Cumberland Plain Woodland (Australia), where D regularly exceeds 2 kPa and can reach 8 kPa in summer. Two commonly used A-gs models were not able to capture the observed decrease in A and gs with increasing D at the leaf scale. To explain this decrease in A and gs, two alternative hypotheses were tested: hydraulic limitation (i.e., plants reduce gs and/or A due to insufficient water supply) and non-stomatal limitation (i.e., downregulation of photosynthetic capacity). We found that the model that incorporated a non-stomatal limitation captured the observations with high fidelity and required the fewest number of parameters. Whilst the model incorporating hydraulic limitation captured the observed A and gs, it did so via a physical mechanism that is incorrect. We then incorporated a non-stomatal limitation into the stand model, MAESPA, to examine its impact on canopy transpiration and gross primary production. Accounting for a non-stomatal limitation reduced the predicted transpiration by ~19%, improving the correspondence with sap flow measurements, and gross primary production by ~14%. Given the projected global increases in D associated with future warming, these findings suggest that models may need to incorporate non-stomatal limitation to accurately simulate A and gs in the future with high D. Further data on non-stomatal limitation at high D should be a priority, in order to determine the generality of our results and develop a widely applicable model.

Equilibration and Increase of Hemoglobin Concentration after One Unit Whole Blood Transfusion among Patients Not Actively Bleeding

Background: Transfusion is a specialized modality of patient management and lifesaving intervention. The decision to transfuse should be individualized, based on a rational approach and taking into account the hemoglobin value in addition to physiologic variables. The purpose of this study was to determine the amount of increase in haemoglobin levels and the rapidity of equilibration after single unit fresh whole blood transfusion in medical inpatients not actively bleeding among the Bangladeshi population.Methods: The present cross sectional study was conducted at the Department of Transfusion Medicine, Dhaka Medical College, Dhaka during the periods of July 2012 to June 2013. Total 100 purposively selected admitted patients in the Department of Medicine of Dhaka Medical College Hospital (DMCH) undergone blood transfusion were included in the study. Demographic characteristics were obtained from the clinical records and by face to face interview. Haemoglobin concentration was measured before transfusion, after 6 hours and 24 hours of transfusion using standard laboratory method. Data were analyzed using SPSS version 16 (SPPS Incorporation, Chicago, IL, USA). Comparison between mean values of haemoglobin was compared with student’s t-test and two-sided P value of 0.05 or less was considered significant.Results: The mean ±SD of the age of the respondents was 24.17±4.96 years with a range of 19 to 45 years and 90.0% were male and 10.0% were female. Previous blood donation history present in 72.0% respondents and absent in 28.0% respondents. Mean±SD of Hb level before, 6 hours and 24 hours after transfusion were 7.64±1.05, 8.03±1.07 and 8.78±1.19 gm/dl respectively. In the present study the mean increase of Hb 6 hours and 24 hours after transfusion were 0.39 gm/dl and 1.14 gm/dl respectively. Comparison between mean Hb level of before transfusion with 6 hours and 24 hours after transfusion revealed a statistically significant difference. Comparison between mean Hb level at 6 hours and 24 hours after transfusion also revealed a statistically significant difference.Conclusion: The study revealed slightly more one gram increase of Hb at 24 hours after transfusion of one unit of whole blood among patients not actively bleeding. There is significant difference between Hb level at 6 hours and 24 hours after transfusion.J Dhaka Medical College, Vol. 23, No.2, October, 2014, Page 161-166

Sensitivity and Specificity of Electroencephalography (EEG) Among Patients Referred to an Electrophysiology Lab in Bangladesh

Objective: To measure the changes in electro encephalogram (EEG) along with its sensitivity and specificity with clinical seizure among epilepsy patients referred to an electrophysiology lab in a tertiary care hospital of Bangladesh.Methods: This retrospective chart review was carried out in the electrophysiology laboratory of Dhaka Medical College Hospital from January 2011 to December 2013, which included 1154 patients. EEG was obtained through scalp electrodes following international 10/20 system. Information regarding patients was collected from the laboratory register with the help of a checklist. The EEG findings and clinical seizure events were then compared.Result: Among the 1154 patients, age varied from birth to 75 years. The mean age at presentation was 17±11.4 years and most of the patients were less than 10 years old (44.4%). The male predominated in our study (59.2%). Clinically diagnosed seizure was present in 970 patients (84.1%), among which Generalized tonic clonic seizure (GTCS) was the most common clinical type of seizure, followed by secondary generalized seizure in 19.4% (n=224) and focal seizure in 2% (n=30) patients and 6.8% (n=79) patients had pseudoseizure. Among the abnormal EEG (59%), generalized epileptiform discharge was found in 29%, whereas focal and secondary generalized discharge was found in 30%. The most common site of origin of epileptiform discharge was temporal lobe (28.3%). The overall sensitivity of EEG was 66% (ranged from 62% to 68% with a confidence interval (CI) at 95%) and specificity was 79% (72- 84% at 95% CI). The positive predictive value was 58% (55-61% at 95% CI) and negative predictive value was 41% (38-44% at 95% CI).Conclusion: Our study brings out the fact that EEG has a reasonable sensitivity and specificity as a diagnostic test and the superiority being the higher specificity of EEG.J Dhaka Medical College, Vol. 23, No.2, October, 2014, Page 215-222

The personal telemedicine system. A new tool for the delivery of health care

An inexpensive home telemedicine system has been developed, comprising a personal telemedicine unit in the patient's home connected by ordinary telephone lines to a central nursing station. Using this system a nurse or other health-care professional at the central station was able to make a 'video visit' to the patient's home. In a preliminary trial, patients were referred by the patient's physician or by a home-care nurse. All 12 patients learned to use the personal telemedicine unit easily and effectively, and there were no complications related to its use. A significant finding was a reduction in the number of home-care visits in seven of the 12 patients (58%). Telecare using the personal telemedicine system was significantly cheaper than care delivered by conventional routes. The average charge was about $15 for a video visit by a nurse, compared with about $90 for a real visit.

Telemedicine: caring for patients across boundaries

Telemedicine combines computer, video and telecommunications to provide healthcare to patients at distant sites. With the improved camera and transmission technologies of the 1990s, telemedicine can be used in a variety of situations. There are two basic technological systems: live interactive video and still image ("store and forward"). Potential users include patients who live in rural or difficult to reach geographic areas, who are confined (i.e. prison inmates), Telemedicine can allow ambulatory patients to continue living at home rather than moving into costly nursing facilities. Home telemedicine also allows greater responsiveness and higher frequency of visits by home care nurses, potentially reducing future hospital visits and costs. Two home telemedicine models are the personal telemedicine unit and the enhanced personal telemedicine module with pc-based video. Telemedicine technologies developed by the military for use on the battlefield that could be adapted for civilian use include medical simulations, individual monitoring devices and biosensors, portable retinal display monitors, life support for trauma/transport, and diagnostic ultrasound imagery. Ultimately, the benefits of telemedicine will be consistency of care, easy access to specialized consultants, higher responsiveness to patient needs, and lower overall healthcare costs.

Telemedicine--a new idea for home care

Telemedicine could prove to be an important tool in the delivery of home care. Early experience indicates that it keeps patients home, reducing emergency room visits, rehospitalization, and institutionalization. How does it work?

Home chemotherapy. A mobile delivery system

CareVan Medical Systems specializes in home chemotherapy, differing from other services in its physician involvement. CareVan provides increasing services and advantages to cancer patients receiving treatment at home.

Home heparin infusion in the management of deep vein thrombophlebitis

Feasibility of home Heparin infusion in the management of deep vein thrombophlebitis (DVT) was assessed in 15 patients. Patients with chest pain, dyspnea, bleeding tendencies, immediate postoperative state, and lack of reliable care giver were excluded. Five patients received the entire course of Heparin infusion at home and 10 were initially started on Heparin in the hospital. Regular assessment and monitoring of blood coagulation parameters were performed by a visiting home nurse clinician in consultation with the attending physician. Eleven physicians were involved in this management and made a total of six physician home visits. Results showed improvement in all but one patient, who had advanced malignancy and resistant thrombophlebitis and who eventually died. No complications occurred among the patients studied. Patient and family surveys indicated a high degree of satisfaction and preference for this modality of care. Analysis of cost indicated a 48% savings compared with similar treatment administered in a hospital setting.

Endemic goitre in the Gilgit Agency, West Pakistan with an appendix on dermatoglyphics and taste-testing

A study has been made of an iodine-deficient population living in an extended village in the Karakoram Himalayas. There is evidence that the incidence of goitre increases towards the lowest part of the village, in accordance with the findings of McCarrison, who worked in the same region in the early years of the twentieth century. McCarrison ascribed the variation of goitre incidence to increasing pollution of drinking water as it travelled downstream, and postulated a bacteriological goitrogenic factor. However, the observations reported here show no correlation between goitre incidence and the bacterial concentration of drinking water, nor are there iodine-metabolizing micro-organisms present in the water. It may be that a differential iodine deficiency throughout the village can account for the variation in goitre incidence, since the soil can adsorb appreciable amounts of radio-iodine. The indices of thyroid function show that all the inhabitants are exceptionally iodine-deficient, although most of them are clinically euthyroid. As well as having a greatly enhanced mean thyroid iodide clearance the population has a mean renal iodide clearance which is lower than normal. Intra-muscular injections of iodized oil were acceptable to the villagers, and 477 injections were administered. Fingerprints and palm prints were collected from a sample of the population, yielding a pattern distribution comparable with other populations in the Indian subcontinent. The ratio of PTC tasters to non-tasters among the inhabitants is not significantly different from the ratio found in Europe.