Recent Advances on Nitrogen-Doped Porous Carbons Towards Electrochemical Supercapacitor Applications

Due to ever-increasing global energy demands and dwindling resources, there is a growing need to develop materials that can fulfil the World's pressing energy requirements. Electrochemical energy storage devices have gained significant interest due to their exceptional storage properties, where the electrode material is a crucial determinant of device performance. Hence, it is essential to develop 3-D hierarchical materials at low cost with precisely controlled porosity and composition to achieve high energy storage capabilities. After presenting the brief updates on porous carbons (PCs), then this review will focus on the nitrogen (N) doped porous carbon materials (NPC) for electrochemical supercapacitors as the NPCs play a vital role in supercapacitor applications in the field of energy storage. Therefore, this review highlights recent advances in NPCs, including developments in the synthesis of NPCs that have created new methods for controlling their morphology, composition, and pore structure, which can significantly enhance their electrochemical performance. The investigated N-doped materials a wide range of specific surface areas, ranging from 181.5 to 3709 m2  g-1 , signifies a substantial increase in the available electrochemically active surface area, which is crucial for efficient energy storage. Moreover, these materials display notable specific capacitance values, ranging from 58.7 to 754.4 F g-1 , highlighting their remarkable capability to effectively store electrical energy. The outstanding electrochemical performance of these materials is attributed to the synergy between heteroatoms, particularly N, and the carbon framework in N-doped porous carbons. This synergy brings about several beneficial effects including, enhanced pseudo-capacitance, improved electrical conductivity, and increased electrochemically active surface area. As a result, these materials emerge as promising candidates for high-performance supercapacitor electrodes. The challenges and outlook in NPCs for supercapacitor applications are also presented. Overall, this review will provide valuable insights for researchers in electrochemical energy storage and offers a basis for fabricating highly effective and feasible supercapacitor electrodes.

Role of Rehabilitation Exercise on Myofascial Pain Syndrome Causing Upper Back Pain

Upper back pain is as painful or troublesome as the pain in the lower back or the neck. Myofascial pain syndrome which is most common cause of upper back pain is characterized by localized musculoskeletal pain and tenderness in association with trigger points. The aim of the study was to correlate the improvement of myofascial pain syndrome patients with proper and timely physical therapy. This quasi experimental study was conducted in the department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh, from 1st January 2008 to 31st August 2008 to see the role of rehabilitation exercise on myofascial pain syndrome causing upper back pain. Sixty (60) patients of myofascial pain syndrome causing upper back pain were randomly assigned for treatment; out of which 23(38.33%) were male and 37(61.66%) were female. The male and female ratio was 1:1.6. The patients selected for the trial were divided into two groups: Group A and Group B. In group A (n=28) the patients were treated with thermotherapy- Microwave diathermy, non-steroidal anti inflammatory drugs and activities of daily living instructions and in Group B (n=32) with same interventions in addition to rehabilitation exercises. Treatment duration was 6 weeks. The difference of treatment improvement was statistically significant (p<0.05) from 1st week up to 6th week. After complete course of treatment 67.86% patients in Group A and 78.13% patients in group B reported improvement. So rehabilitation exercises can be a valuable adjunct to other modalities of treatment of myofascial pain syndrome causing upper back pain.

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

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

Role of Serum Triglyceride to Detect Severity and Outcome in Acute Pancreatitis

Though hypertriglyceridemia is an established risk factor for acute pancreatitis, the relationship between hypertriglyceridemia and pancreatitis-associated complications remains controversial. Serum triglyceride could be a simple, routinely available investigation if predictability of the outcome can be validated. Due to scarcity of related studies in Bangladesh, this study aimed to evaluate the role of serum triglyceride to detect severity and outcome in acute pancreatitis. This prospective observational study was conducted in the Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD), BIRDEM General Hospital, Dhaka from April 2019 to January 2021. A total of 153 patients with confirmed diagnosis of acute pancreatitis were selected as study cases according to selection criteria. Detailed clinical and demographic history of each patient was taken along with physical examination and relevant investigations. Developed complications and mortality were also assessed during hospital stay. Collected data were checked for errors and analyzed by using the statistical software SPSS 23.0. The mean age ±SD of the study population was 46.72±13.43 years with a majority in age group 41-50 years (30.10%). About 51.60% patients were male and 48.40% patients were female. Higher frequency of severe cases of acute pancreatitis (according to Glasgow score, BISAP score and Ranson score) was observed in patients with hypertriglyceridemia than patients with normal triglyceride with statistical significance (p<0.05). Mortality and complications were also more frequent in patients with acute pancreatitis with statistical significance (p<0.05). With a cut off value of 218mg/dl, serum triglyceride showed 68.66% sensitivity, 66.28% specificity and 67.32% accuracy for predicting outcome of acute pancreatitis. Findings of this study suggest that serum triglyceride might play a recommendable role in predicting the severity and outcome of patients with acute pancreatitis. However, further extensive study is recommended.

Study on Myocardial Infarction in Young Adults: Risk Factor Analysis

Coronary heart disease (CHD) imposes a significant burden on health care systems because of high morbidity and mortality. There is documented evidence that South Asian people develop CHD at a higher rate and at an early age. If the affected individual is 40 years old or below, the tragic consequences are catastrophic. Identifying risk factors could be important for health promotion. The objectives of this study were to determine the frequency of risk factors in young patients with acute myocardial infarction and thus with ischemic heart disease (IHD) aged 40 years and below in our population. It was a descriptive observational study which was carried out at Coronary Care Unit of Rajshahi Medical college Hospital, Rajshahi, Bangladesh in 61 patients from January 2011 to June 2011. All patients who fulfilled the inclusion criteria admitted to coronary care unit (CCU) with a diagnosis of Acute MI were included. Their detailed history was then taken including symptoms at presentation and their risk factors were assessed according to the Framingham Risk Scoring System with the help of history and laboratory investigations. Mean age ±SD of the patients was 36±3.7 year. Most of the patients were male. Smoking was the major risk factor (73.8%) followed by family history of IHD (44.3%). Other risk factors were dyslipidaemia (39.35%), hypertension (37.7%), obesity (11.5%) and diabetes mellitus (8.2%). Majority of the patients were adopted in sedentary lifestyle. 91.8% patient presented with chest pain. Other symptoms were dyspnoea (37.7%), palpitation (59.0%), sweating (77.0%), nausea, vomiting (50.8%) and impaired consciousness (19.7%) etc. Most frequent risk factor for acute myocardial infarction (MI) at young age is smoking followed by family history of MI and dyslipidaemia. Majority of the patients had two or more than two identifiable antecedent risk factors.

Serum Electrolyte Status of Patients with Acute Stroke Admitted in a Tertiary Care Hospital

Stroke, usually a focal rather than global neurological deficit resulting from vascular origin with sudden onset, may be with cerebral infarction or intracerebral haemorrhage. It results in brain oedema following vascular injury and electrolyte imbalance. A descriptive cross sectional study was carried out in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh during March 2016 to May 2018 to assess the electrolyte levels among 220 purposively selected patients with stroke confirmed by CT scan. Data were collected by the principal investigator himself by using interview schedule and case record form after attaining consent. Blood samples were collected from the patients to carry out biochemical and haematological tests and to assess serum electrolyte levels. Data were cross-checked for completeness, consistency and relevancy, and were analyzed by computer software SPSS 20.0. Age was significantly higher in haemorrhagic stroke (64.88±13.00 years) than ischaemic stroke (60.92±13.96 years). Male (55.91%) were predominant than female (44.09%). One hundred nineteen (54.09%) patients had ischaemic stroke and 101(45.91%) patients had haemorrhagic stroke. The serum concentration of Na+, K+, Cl- and HCO₃- were measured during acute period of stroke. Imbalance in serum Sodium, Chloride, Potassium and Bicarbonate level were observed in 37.27%, 29.55%, 23.18% and 6.36% patients respectively. Hyponatremia, hypokalemia, hypochloremia and acidosis were most common electrolyte imbalance in both ischaemic and haemorrhagic strokes. In ischaemic stroke hyponatremia was 35.29%, hypernatremia was 3.36%, hypokalemia 19.33%, hyperkalemia 0.84%, hypochloraemia 30.25%, hyperchloraemia 3.36%, acidosis was in 6.72% and alkalosdis in 1.68% patients while in haemorrhagic stroke hyponatremia 33.66%, hypernatremia 1.98%, hypokalaemia 22.77% hyperkalemia 3.96%, hypochloremia 19.80%, hyperchloraemia 4.95%, acidosis 2.97% and alkalosis was in 0.99% of patients. Mortality was more in hyponatremic, hypokalemic and in hypochloremic patients.

Clinical and Liver Enzymes among the Patients with Metabolic Syndrome with or without Non Alcoholic Fatty Liver Disease attending a Tertiary Care Hospital

Metabolic syndrome is characterized by central obesity, dyslipidemia, raised blood pressure and impaired blood sugar levels. Patients with metabolic syndrome are at increased risk of type 2 diabetes and atherosclerotic cardiovascular disease. This cross-sectional observational study was carried out from January 2019 to December 2019 at the inpatient and outpatient department of BIRDEM General Hospital, Dhaka, Bangladesh. Adult subjects aged ≥18 years with metabolic syndrome (IDF criteria, 2006) were included and purposive sampling was done. A total of 242 participants were included and the mean age was 40.2±14.1 years ranging from 18-70 years. Among them, 140(57.85%) were female and 102(42.15%) were male. Out of 242 participants, 170(70.25%) subjects had Metabolic Syndrome (MetS) with Non-Alcoholic Fatty Liver (NAFLD) and 72(29.75%) subjects had metabolic syndrome without NAFLD. In the male participants, the mean waist-hip ratio (WHR) of MetS with NAFLD and MetS without NAFLD was 1.01±0.07 vs. 0.96±0.08 respectively (p-value 0.003). In female subjects, the mean waist-hip ratio (WHR) of MetS with NAFLD and MetS without NAFLD group was 0.90±0.10 vs. 0.86±0.08 respectively (p-value 0.026). MetS with NAFLD subjects were more hypertensive than MetS without NAFLD subjects (61.2% vs. 42.7%). In the MetS with NAFLD group (n=170), 11.8% was normoglycemic, 43.5% was prediabetic and 44.7% was diabetic. In the MetS without NAFLD group (n=72), 19.5% was normoglycemic, 50% was prediabetic and 30.5% was diabetic. SGPT value was significantly raised in MetS with NAFLD subjects (56.4%) than MetS without NAFLD (38.9%) subjects (p-value 0.038). SGOT value was significantly raised in MetS with NAFLD subjects (58.8%) than MetS without NAFLD subjects (41.7%); (p-value 0.005). Mean Total Cholesterol and Triglyceride were significantly raised in MetS with NAFLD subjects than MetS without NAFLD subjects (p-value 0.01). In Subjects with grade I fatty liver, mean SGPT and SGOT were 42.27±22.31 vs. 39.59±16.93 respectively. In Subjects with grade II fatty liver, mean SGPT and SGOT were 62.13±32.42 vs. 52.45±28.56 respectively. In grade III fatty liver, mean SGPT and SGOT were 51.50±32.19 vs. 41.00±17.52 respectively (p value <0.001). More than two-third of participants with metabolic syndrome had non-alcoholic fatty liver disease (NAFLD) and a significant elevation of liver enzymes than metabolic syndrome without NAFLD participants. About 85.0% of metabolic syndrome participants had glucose intolerance in the form of prediabetes and diabetes.

Recent Advances in Stretchable and Wearable Capacitive Electrophysiological Sensors for Long-Term Health Monitoring

Over the past several years, wearable electrophysiological sensors with stretchability have received significant research attention because of their capability to continuously monitor electrophysiological signals from the human body with minimal body motion artifacts, long-term tracking, and comfort for real-time health monitoring. Among the four different sensors, i.e., piezoresistive, piezoelectric, iontronic, and capacitive, capacitive sensors are the most advantageous owing to their reusability, high durability, device sterilization ability, and minimum leakage currents between the electrode and the body to reduce the health risk arising from any short circuit. This review focuses on the development of wearable, flexible capacitive sensors for monitoring electrophysiological conditions, including the electrode materials and configuration, the sensing mechanisms, and the fabrication strategies. In addition, several design strategies of flexible/stretchable electrodes, body-to-electrode signal transduction, and measurements have been critically evaluated. We have also highlighted the gaps and opportunities needed for enhancing the suitability and practical applicability of wearable capacitive sensors. Finally, the potential applications, research challenges, and future research directions on stretchable and wearable capacitive sensors are outlined in this review.

Psychiatric Morbidity in Irritable Bowel Syndrome

Psychiatric morbidity is frequent among outpatients with Irritable Bowel Syndrome (IBS) attending gastroenterology clinics. The lifetime prevalence of major depressive and anxiety disorders in IBS patients are up to 76% and 54% respectively. The point prevalence of Major depressive disorder and Anxiety disorders in IBS patients are ranged 9.6 to 54% and from 11.1 to 52.4% respectively. IBS is not usually life-threatening but it has a significant impact on quality of life. So, screening for psychiatric disorders in IBS patients attending Gastroenterology clinics is worthwhile. The objective of this study was to evaluate psychiatric morbidity among the patients with IBS. This cross sectional comparative study was conducted in the Department of Psychiatry, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh during the period from January 2012 to June 2012. Inclusion criteria were patients of irritable bowel syndrome fulfilling the Rome-III criteria, age between 18 to 60 years irrespective of sex. Patients with any red flag sign, serious cognitive impairment such as dementia, schizophrenia, mania, delusional disorder, prior history of abdominal surgery and other chronic diseases were excluded. One hundred and ten patients with IBS were selected according to inclusion and exclusion criteria and categorized as IBS group. Another 110 age and sex matched subjects were selected as control group. The mean±SD age of the patients was 34.3±12.2 years which was almost identical to control group (p=0.820). Most of the patients (66.4%) were below the age of 40 years. There were 64 (58.2%) male and 46 (41.8%) female which was similar to control group (p=0.643). Psychiatric co-morbidity was most frequent in IBS patients (56.4%) as compared to control group (16.4%) p value <0.001. The most common psychiatric disorders were Anxiety disorders (22.7%), followed by major depressive disorder (19.1%) and somatization disorder (14.5%). The results of this study suggest that a significant number of patients with IBS suffer from psychiatric disorders than control, which are similar to the IBS group in age and gender.

Recent Progress, Challenges, and Opportunities of Membrane Distillation for Heavy Metals Removal

Water is essential for the presence of life on this earth. However, water contamination due to the presence of heavy/toxic metals is one of the serious environmental issues for living beings. Several methods have been devoted to separating or removing those heavy metals from wastewater. Among them, membrane distillation (MD) has become one of the most attractive approaches due to its higher rejection rate than processes driven by pressure, lower energy consumption than traditional distillation processes. MD has gained significant attention for removing heavy metals than other techniques like ion exchange and adsorption in the last two decades. This review provides insight knowledge to the reader and focuses on how heavy metals impact humans and the environment, sources of heavy metals, current and especially removal methods using the MD method. Moreover, recent studies, challenges, and opportunities on MD membrane modules and heavy metal removal systems are discussed. More importantly, in this review, we have identified the gaps and opportunities that are required for enhancing the MD approach and its practical suitability for heavy metal removals. MD module and system showed high performance, proving their possible applications to remove heavy metal ions in water/wastewater treatment.

Review on diagnosis and molecular characterization of Toxoplasma gondii in humans and animals

Toxoplasma gondii is an obligate intracellular protozoon which causes toxoplasmosis, an important zoonotic disease that is endemic worldwide. Common sources of T. gondii infection in humans are food or water contaminated with oocysts and raw or undercooked meat with cysts. In animals, common sources of infection include feed, water, or litter contaminated with oocysts. The diagnosis and molecular characterization of T. gondii infection in humans and animals is crucial due to public and veterinary health importance. Various traditional and serological methods have been used in clinical practice for toxoplasmosis diagnosis, but interpreting the results remains a challenge. Several molecular techniques have also been used for the detection and genetic characterization of T. gondii , but primarily in research settings. In this paper, we review the techniques that are currently used for the diagnosis and genetic characterization of T. gondii in humans and animals, along with their advantages and disadvantages. The techniques reviewed have laid the groundwork for the future development of more effective and precise detection and characterization of T. gondii . These advances will contribute to a better understanding of epidemiology, prevention and control of toxoplasmosis. Thus, this review would be of particular interest to clinical physicians, veterinarians and researchers.

A Study on the Interfacial Compatibility, Microstructure and Physico-Chemical Properties of Polyimide/Organically Modified Silica Nanocomposite Membrane

Polyimide-silica (PI-Silica) composites are of tremendous research interest as high-performance materials because of their excellent thermal and mechanical properties and chemical resistance to organic solvents. Particularly, the sol-gel method of fabricating such composites is popular for manipulating their properties. In this work, PI-silica composite films are synthesized by the sol-gel method and thermal imidization from the solution mixtures of hydrolyzed tetraethoxysilane (TEOS) (or glycidoxypropyltrimethoxysilane (GPMS)) modified silica and an aromatic polyamic acid (PAA) based on 3,3',4,4'-biphenyl tetracarboxylic dianhydride (BPDA)-p-phenylenediamine (PDA). The phase morphology of composites is found to be controlled by the substitution of TEOS with GPMS. Solid-state NMR spectroscopy is used to confirm the structural components of silica and GPMS-modified silica, whereas FT-IR results confirm the complete imidization of polyimide and composite film and suggest successful incorporation of Si-O-Si bonds into polyimide. The thermal, optical transmittance, and dielectric constant characterizations of pure polyimide and composite films are also carried out. Thermal stability of pure polyimide is found to be increased significantly by the addition of silica, whereas the partial substitution of TEOS with GPMS decreases the thermal stability of the composite, due to the presence of the alkyl organic segment of GPMS. The optical transmittance and dielectric constant of the composite films are controlled by manipulating the GPMS content.

Study on Alanine Aminotransferase in Patients of Type 2 Diabetes Mellitus

Type 2 Diabetes mellitus (DM) is associated with various types of liver disorders including elevated liver enzymes. This study was carried out to observe hepatocellular injury in type 2 Diabetes mellitus as evidenced by raised Alanine aminotransferase (ALT) among the type 2 Diabetes mellitus patients and to find out association between elevated ALT and glycaemic control. This was a descriptive cross-sectional comparative study carried out in Department of Medicine, Rajshahi Medical College Hospital and Rajshahi Diabetic Association Hospital, Rajshahi, Bangladesh from July 2009 to June 2010. One hundred (100) diagnosed type 2 diabetic patients according to WHO criteria and 30 apparently healthy people of both sexes were included. Age of the study people were >40 years. All of those study population were free from taking any hepatotoxic drugs, inj. Insulin, alcohol and preexisting liver disease. Detailed History, thorough clinical examination and relevant investigations were done for exclusion. The frequency of abnormal ALT, Serum bilirubin, Aspartate aminotransferase (AST), Alkaline phosphatase, Prothrombin time and Serum albumin were 30%, 6%, 7%, 6%, 54% and 12% respectively in type 2 diabetic patients and 3.3%, 00%, 00%, 6.7%, 10% and 3.3% respectively in normal people. Serum ALT (U/L) level (mean±SD) of the type 2 diabetic patients and normal people were (39.00±24.21) and (28.26±6.67) respectively. This difference is highly significant (p<0.001). Elevated serum ALT level of type 2 diabetic patients showed positive association with increased Body mass index (BMI) (p<0.05) and poor glycaemic control (p<0.05) and fatty liver (p=0.055). So, a high proportion of patients with type 2 diabetes mellitus have raised serum Alanine aminotransferase level. Elevated serum ALT level was also associated with high BMI, poor glycaemic control and fatty liver which may be a marker of NAFLD and insulin resistance.

Alvarado versus RIPASA Score for the Diagnosis of Acute Appendicitis

The aim of the present study was to compare the sensitivity between Alvarado and RIPASA score for the diagnosis of acute appendicitis patients. A comparative study was conducted in the Dhaka National Medical College Hospital, Bangladesh from July 2015 to December 2015. The study was approved by the institutional ethical committee. Most of the appendicitis patients belonged to the between 21-30 years which was 64(32%). Male appendicitis patients (52%) are more than the female patients (48%). Majority of the patients (69%) complains pain occurs in the Right iliac fossa. Sensitivity of Alvarado scores was 81.60%, specificity 74.58%, accuracy 79.35%, positive and negative predictive values were 87.18% and 65.67% respectively. RIPASA score's sensitivity was 85.6%, specificity 69.49%, accuracy 80.40%, positive and negative predictive values were 85.60% and 85.60% respectively. This study reported that RIPASA score is significantly shown higher diagnostic accuracy then that Alvarado score.

Relation between Serum Magnesium Level and Migraine

Migraine is one of the most disabling types of headache. It affects 4-6% of men and 13-18% of women; more than 80% of them are under 30 years. Many theories to explain mechanism of migraine are present; role of serum magnesium is one of them. This Cross-sectional analytical study was designed to see serum magnesium level status of migraine patients in Bangladesh and to find out any relation. The study was carried out in Outpatient Department of Neurology of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2017 to September 2018. Seventy (70) patients between 18-60 years of both sexes with headache fulfilling the criteria for migraine were enrolled as migraine group. Patients with headache who did not fulfill the criteria of migraine enrolled as non migraine group. Patients were included in both groups after exclusion of structural lesions, magnesium containing drug intake, pregnancy, menstruation, alcoholism, renal or GIT problems. Serum magnesium levels were studied in both groups and compared with each other. All related factors such as age, sex, family history of migraine, occupation were assessed. Fifty one (51) of 70 patients (72.85%) was female and 19(27.15%) were male in migraine group. Thirty eight (54.28%) of cases were between 18 and 30 years old. Thirty nine (55.71%) of migraine patients had history of similar headache in their family. Severe headache in 51.43% of migraine patients and 30% had more than three attacks per month. Mean serum magnesium level was 1.70 mg/dl in migraine group and 1.85 mg/dl in non migraine group (p=0.001). Serum magnesium level was also lower in severe migraine headache in comparison to mild to moderate headache (p=0.01). No significant difference was found in serum magnesium level compared according to age, sex, frequency of attack and presence or absence of aura. The study concludes that serum magnesium in migraine patients was significantly lower than non migraine group. It was also lower in migraine patient having severe headache in comparison with mild to moderate headache, though in both conditions they were within normal range.

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.

Prevalence of dyslipidemia and associated risk factors among newly diagnosed Type-2 Diabetes Mellitus (T2DM) patients in Kushtia, Bangladesh

Dyslipidemia is considered a significant modifiable risk factor for type-2 diabetes mellitus (T2DM) and has become one of the emerging health problems throughout the world. In Bangladesh, data on dyslipidemia among newly diagnosed T2DM patients are comparatively inadequate. This study aimed to evaluate the prevalence of dyslipidemia and its associated risk factors in newly diagnosed T2DM patients. This cross-sectional study was conducted by a well-structured questionnaire from 132 newly diagnosed type-2 diabetic patients attending the Mujibur Rahman Memorial Diabetic Hospital in Kushtia, Bangladesh. Data regarding socio-demographic, anthropometric, fasting blood glucose, total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were collected from all the respondents. The association between dyslipidemia and its associated factors was analyzed using the multivariate logit regression model. The findings suggest that the prevalence rate of dyslipidemia was 75.7% in female and 72.6% in male T2DM patients. The odds of having dyslipidemia were 1.74 (95% Cl: 1.58-1.87) times significantly higher in female (p<0.001). The other factors associated with dyslipidemia encompassed age between 30-39 years (OR: 2.32, 95% CI: 1.97-2.69), obesity (OR: 2.63, 95% CI: 2.27-2.90), waist circumferences of male ≥90 and female ≥80 (OR: 1.65, 95% CI: 1.59-1.89), hypertensive patients (OR: 1.51, 95% CI: 1.45-1.74), physically inactive (OR: 3.25, 95% CI: 1.84-4.68), and current smoker or tobacco user (OR: 1.93, 95% CI: 1.85-2.13). This study concluded that the high prevalence of dyslipidemia was found among newly diagnosed type-2 diabetes patients and associated with gender, age, BMI, waist circumference, poor physical activity, and smoking, or tobacco use. This result will support increase awareness of dyslipidemia and its associated risk factors among type-2 diabetes patients.

Study of low-peak-power highly coherent broadband supercontinuum generation through a dispersion-engineered Si-rich silicon nitride waveguide

Since the first observation by Alfano and Shapiro in the 1970s [Phys. Rev. Lett.24, 584 (1970)PRLTAO0031-900710.1103/PhysRevLett.24.584], supercontinuum generation study has become an attractive research area in the field of broadband light source design, including its use in various applications associated with nonlinear optics in recent years. In this work, the numerical demonstration of ultrabroadband supercontinuum generation in the mid-infrared (MIR) region via the use of complementary metal-oxide semiconductor compatible Si-rich silicon nitride as the core in a planar waveguide design employing one of two materials, either LiNbO₃ or MgF₂ glass, as the top and bottom claddings is explored. A rigorous numerical investigation of broadband source design in the MIR using 2 mm long Si-rich silicon nitride waveguides is carried out in terms of waveguide structural parameter variations, input peak power variation, varying unexpected deformation of the waveguide along the core region during fabrication, and spectral coherence analysis. Among the several waveguide models studied, two promising designs are identified for wideband supercontinuum generation up to the MIR using a relatively low input peak power of 50 W. Simulation results reveal that spectral coverage spanning from 0.8 µm to 4.6 µm can be obtained by using a LiNbO₃-cladded waveguide, and similar spectral coverage is also predicted for the other design, a MgF₂-cladded waveguide. To the best of our knowledge, this is the widest spectral span in the MIR region employing a Si-rich silicon nitride waveguide so far. In dispersion tuning as well as in supercontinuum generation, the effect of possible unexpected waveguide deformation along the transverse directions during fabrication is also studied. No significant amount of spectral change is observed in the proposed model for a maximum of 10° inside/outside variation along the width. On the other hand, even 1° upward/downward variation along the thickness could cause substantial spectral change at the waveguide output. Finally, the obtained output spectra from the proposed waveguides are found to be highly coherent and can be applied in various MIR region applications such as optical coherence tomography, spectroscopic measurement, and frequency metrology.

Computational Approach to Understanding the Electrocatalytic Reaction Mechanism for the Process of Electrochemical Oxidation of Nitrite at a Ni-Co-Based Heterometallo-Supramolecular Polymer

Here, we report a semiempirical quantum chemistry computational approach to understanding the electrocatalytic reaction mechanism (ERM) of a metallic supramolecular polymer (SMP) with nitrite through UV/vis spectral simulations of SMP with different metal oxidation states before and after interactions with nitrite. In one of our recent works, by analyzing the electrochemical experimental data, we showed that computational cyclic voltammetry simulation (CCVS) can be used to predict the possible ERM of heterometallo-SMP (HMSMP) during electrochemical oxidation of nitrite (Islam T.ACS Appl. Polym. Mater.2020, 2( (2), ), 273-284). However, CCVS cannot predict how the ERM happens at the molecular level. Thus, in this work, we simulated the interactions between the repeating unit (RU) of the HMSMP polyNiCo and nitrite to understand how the oxidation process took place at the molecular level. The RU for studying the ERM was confirmed through comparing the simulated UV/vis and IR spectra with the experimental spectra. Then, the simulations between the RU of the polyNiCo and various species of nitrite were done for gaining insights into the ERM. The simulations revealed that the first electron transfer (ET) occurred through coordination of NO₂ ^- with either of the metal centers during the two-electron-transfer oxidation of nitrite, while the second ET followed a ligand-ligand charge transfer (LLCT) and metal-ligand charge transfer (MLCT) pathway between the NO₂ species and the RU. This ET pathway has been proposed by analyzing the transition states (TSs), simulated UV/vis spectra, energy of the optimized systems, and highest occupied molecular orbital-lowest occupied molecular orbital (HOMO-LUMO) interactions from the simulations between the RU and nitrite species.

Platelet Count as a Severity of Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary disease (COPD) is a heterogenous respiratory disease characterized by a progressive, not fully reversible airflow limitation associated with an abnormal inflammatory response of the lung to noxious stimuli. It is a disease presenting with pulmonary inflammation as well as a systemic one. Measurement of inflammatory marker is difficult but platelet count estimation is easy and less costly. This descriptive, cross-sectional study was carried out at Department of Medicine, Mymensingh Medical college Hospital, Mymensingh, Bangladesh for a period of twelve months among fifty-nine COPD patients. Data were collected through interview, physical examination and laboratory investigations. Statistical analysis was performed using SPSS version 22.0 for consistency and completeness. Age range of the patients was 40 to 49 years with a mean of 56.3±10.9 years. Age group 40-49 years contained the highest number (19; 32.3%) of patients. Majority 57(96.6%) of the respondents were male. Thirty seven (62.7%) of patients were illiterate. Majority 56(94.9%) of patients resided in rural area, of them most 38(64.4%) were farmers. According to Spirometric measurement among 59 respondents of COPD patient, 3(5.1%) were in GOLD stage-I, 9(15.3%) in GOLD stage-II, 27(45.8%) in GOLD stage-III and 20(33.9%) in GOLD stage IV group. Mean platelet count (10³/μl), 241.6±86.5 was found in mild, whereas 315.0±47.7 in moderate, 337.2±76.3 in severe, and 412.4±67.5 in very severe group of COPD patients. So increase in platelet count is statistically significant in severity of COPD. In conclusion, platelet count measurement is less costly to categorize COPD and may be a diagnostic marker.

N-[(E)-Quinolin-2-ylmethylidene]-1,2,4-triazol-4-amine hemihydrate

The title hemihydrate, C12H9N5·0.5H2O, was isolated from the condensation reaction of quinoline-2-carbaldehyde with 4-amino-4H-1,2,4-triazole. The Schiff base molecule adopts an E configuration about the C=N bond and is approximately planar, with a dihedral angle between the quinoline ring system and the 1,2,4-triazole ring of 12.2 (1)°. In the crystal, one water molecule bridges two Schiff base molecules via O—H...N hydrogen bonds. The Schiff base molecules are interconnected by π–π stacking interactions [centroid-centroid distances of 3.7486 (7) and 3.9003 (7) Å] into columns along [1\overline{1}0].

The fabrication of a chemical sensor with PANI-TiO2 nanocomposites

In this study, conjugated conducting polyaniline was fabricated onto titania nanoparticles (PANI-TiO₂ NPs) using a microwave-accelerated reaction system. The synthesized nanoparticles were characterized using the techniques of electron microscopy (e.g., FE-SEM and TEM), X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FT-IR), and ultraviolet-visible (UV-Vis) spectrometry. An ultrasensitive sensor using the electrochemical (I–V) approach was fabricated using a thin film of PANI-TiO₂ NPs on a glassy carbon electrode (GCE), and it was found to be selective towards 1,2-diaminobenzene (1,2-DAB) in a buffer phase. From current versus concentration studies, the calibration curve was plotted to estimate the sensor's analytical parameters. The highest sensitivity (19.8165 μA μM⁻¹ cm⁻²) and lowest detection limit (0.93 ± 0.05 pM) were obtained from the electrochemical assessment by applying a signal-to-noise ratio of 3. A linear calibration plot was attained over a large range of concentration (LDR: 1.0 pM to 0.01 mM). The selective 1,2-DAB sensor was found to be efficient and reproducible in performance, yielding significant results with a fast response time (12.0 s). Therefore, the overall results of the 1,2-DAB chemical sensor suggest that this detection approach might be an easy way to develop an efficient electrochemical sensor for the protection of the environment as well as for use in the healthcare field on a broad scale.

The conjugated conducting polyaniline was fabricated onto PANI-TiO₂ nanoparticles prepared by microwave-accelerated reaction system for the development an efficient and sensitive electrochemical sensor to protect the environment and healthcare fields in a broad scale.

Tumor-on-a-chip: a microfluidic model to study cell response to environmental gradients

Limited blood supply and rapid tumor metabolism within solid tumors leads to nutrient starvation, waste product accumulation and the generation of pH gradients across the tumor mass. These environmental conditions modify multiple cellular functions, including metabolism, proliferation, and drug response. However, capturing the spatial metabolic and phenotypic heterogeneity of the tumor with classic in vitro models remains challenging. Thus, in this work a microfluidic tumor slice model was developed to study cell behavior under metabolic starvation gradients. The presented microdevice comprises a central chamber where tumor cells were cultured in a 3D collagen hydrogel. A lumen on the flank of the chamber was used to perfuse media, mimicking the vasculature. Under these circumstances, tumor cell metabolism led to the generation of viability, proliferation and pH gradients. The model decoupled the influence of oxygen from other nutrients, revealing that cell necrosis at the core of the model could be explained by nutrient starvation. The microdevice can be disassembled to retrieve the cells from the desired locations to study molecular adaptions due to nutrient starvation. When exposed to these pH gradients and low nutrient conditions, cancer cells showed multiple changes in their gene expression profile depending on their distance from the lumen. Those cells located further from the lumen upregulated several genes related to stress and survival response, whereas genes related to proliferation and DNA repair were downregulated. This model may help to identify new therapeutic opportunities to target the metabolic heterogeneity observed in solid tumors.

Results of Locking Compression Plate (LCP) Fixation in Humeral Shaft Nonunion

Although nonoperative treatment is indicated & successful for the majority of diaphyseal humeral fractures, nonunion is not rare condition. The prevalence of nonunion as a complication of conservative treatment has been reported to be as high as 15%. Locking compression plate combined with autogenous cancellous bone grafting can result in reliable healing of these humeral nonunion with excellent functional outcome. This prospective observational study was conducted September, 2016 to October, 2018 at National Institute of Traumatulogy & Orthopaedic Rehablitation, Dhaka & Mymensingh Medical College, Mymensingh, Bangladesh. Fifteen (15) patients with non-united humeral shaft fractures were treated by open reduction and internal fixation by LCP with autogenous cancellous bone graft. Detailed clinical conditions of all patients, duration of injury, technical difficulty with the implant, hospital stay period were recorded. Follow up period was 6 months. The patients were evaluated clinically and radiologically for outcomes. The progresses of healing as well as occurrence of complications were recorded. The modified Constant and Murley score of functional assessment was used for shoulder & elbow function. Age of the study patients was ranged 20-50 years. Maximum patients were male 12. Mode of injury were found road traffic accident 8 cases, fall from height 5 cases. Right side was injured in 9 patients. Atrophic nonunion was found in 13 patients and hypertropic in 2 patients. The mean union time was 15 weeks. Only one patient had wound infection and 2 patients had shoulder stiffness. Functional outcome which constituted 90% satisfactory results in 13 cases according to modified Constant & Murley scoring system. Union rate was 100%. Therefore, LCP fixation with autogenous cancellous bone graft is a standard treatment method for nonunion of humeral shaft fracture.

Cellular Metabolic Heterogeneity In Vivo Is Recapitulated in Tumor Organoids

Heterogeneous populations within a tumor have varying metabolic profiles, which can muddle the interpretation of bulk tumor imaging studies of treatment response. Although methods to study tumor metabolism at the cellular level are emerging, these methods provide a single time point “snapshot” of tumor metabolism and require a significant time and animal burden while failing to capture the longitudinal metabolic response of a single tumor to treatment. Here, we investigated a novel method for longitudinal, single-cell tracking of metabolism across heterogeneous tumor cell populations using optical metabolic imaging (OMI), which measures autofluorescence of metabolic coenzymes as a report of metabolic activity. We also investigated whether in vivo cellular metabolic heterogeneity can be accurately captured using tumor-derived three-dimensional organoids in a genetically engineered mouse model of breast cancer. OMI measurements of response to paclitaxel and the phosphatidylinositol-3-kinase inhibitor XL147 in tumors and organoids taken at single cell resolution revealed parallel shifts in metaboltruic heterogeneity. Interestingly, these previously unappreciated heterogeneous metabolic responses in tumors and organoids could not be attributed to tumor cell fate or varying leukocyte content within the microenvironment, suggesting that heightened metabolic heterogeneity upon treatment is largely due to heterogeneous metabolic shifts within tumor cells. Together, these studies show that OMI revealed remarkable heterogeneity in response to treatment, which could provide a novel approach to predict the presence of potentially unresponsive tumor cell subpopulations lurking within a largely responsive bulk tumor population, which might otherwise be overlooked by traditional measurements.

Management of Distal Third Comminuted Humerus Shaft Fracture by LCP Using Posterior Approach

Distal third comminuted humerus shaft fractures are challenging injuries to treat because of complex anatomy and fracture patterns. Functional bracing, operative treatment with intramedullary nails or conventional plates also has limitation of inadequate fixation in the distal third comminuted humerus shaft fractures. Locking compression plate (LCP) has been introduced to overcome this problem. Our aim of this study was to assess the effectiveness of osteosynthesis of distal third comminuted humerus shaft fractures by LCP using posterior approach. This prospective observational study was conducted from July 2015 to June 2018 at Mymensingh Medical College Hospital (MMCH) and National Institute of Traumatulogy & Orthopaedic Rehablitation (NITOR), Dhaka, Bangladesh. Thirty three patients were operated on for comminuted fractures of distal third humerus. Two cases were excluded from the evaluation of final out come due to their discontinued follow up. Treatment included open reduction and LCP fixation by posterior mid line approach. The range of motion of the shoulder and elbow were evaluated according to the criteria by modified Constant and Murley scoring system. Union was achieved in all the patients after a mean of 17 weeks (range 12-24 weeks). Deep infection, nonunion, malunion, implant failure or permanent nerve injury did not occur in any of the patients. Three patients had transient radial nerve palsy. Four patients developed superficial infections. All patients were relieved pain postoperatively. Shoulder range of motion was excellent in 20 patients & elbow range of motion was excellent in 21 patients. Functional out come were excellent in 11 & good in 16 patients which constituted 87% satisfactory results. Treatment with open reduction and LCP fixation by posterior approach is a safe and effective option in distal third comminuted humeral fractures.

Patient-derived colorectal cancer spheroids for single cell characterization of intratumor heterogenity in response to EGFR inhibition

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Background: Epidermal growth factor receptor inhibitors (EGFRi) have improved clinical outcomes in patients (pts) with metastatic colorectal cancer (mCRC). Molecular profiling and primary tumor sidedness are used to predict population benefit. Our group has recently demonstrated that patient-derived organotypic cancer spheroids (PDOCS) and optical metabolic imaging (OMI) can predict in vivo chemotherapy response. Translational tools are needed to characterize targeted therapeutic response to predict clinical outcomes. Methods: PDOCS were generated from patients with mCRC at time of molecular profiling. Following culture maturation, PDOCS were treated with physiologic doses of EGFRi panitumumab. Response was evaluated by change in sphere diameter and OMI to exploit intrinsic autofluorescence of NAD(P)H and FAD at spheroid and single-cell level. Effect size was calculated using Glass’s delta (GΔ) defined as differences in means between treatment groups normalized to control standard deviation with comparison to predetermined sensitivity thresholds. Results: PDOCS from pts with mCRC were generated from tissue biopsies, surgical specimens, and malignant effusions (n = 38). Mutational profiles were stratified by RAS status from next-generation sequencing. Six PDOCS were evaluable for experimental and clinical response. KRAS mutation predicted primary resistance to EGFRi with no difference in diameter (GΔ = -0.01) or single cell response by OMI (GΔ = 0.02). RAS wild-type PDOCS had significant response with decreased diameter with EGFRi (P < 0.001). Gaussian fit of single-cell analyses revealed heterogeneity in EGFRi sensitivity. Differential sensitivity to EGFRi in RAS wild-type population correlated with clinical response. Conclusions: PDOCS predict response to panitumumab in these preliminary investigations. Diameter and OMI analyses provide complementary information of line-specific sensitivity. Further studies are warranted to characterize the molecular profiles underlying intratumor heterogenity. Prospective investigations are needed to understand the predictive role of this technique in targeted therapeutic response.

Fabrication of 1,4-dioxane sensor based on microwave assisted PAni-SiO2 nanocomposites

In this study, conducting polyaniline (PAni) and silicon dioxide (SiO₂) nanocomposites (NCs) were synthesized for chemical sensing applications by microwave assisted reaction technique. Facile synthesis and characterization of the PAni-SiO₂ nanocomposites were investigated in details and discussed in this report. For the potential application, 1,4-dioxane chemical sensor was fabricated with the PAni-SiO₂ nanocomposites deposited onto glassy carbon electrode (GCE). A very thin uniform film was deposited onto GCE with nanocomposite by using conducting 5% nafion binder at room conditions. To evaluate the sensor analytical performances, a calibration plot such as current versus concentration of 1,4-dioxane was drawn and calculated the analytical parameters from the slope of calibration curve. Results are found as sensitivity (0.5934 µAµmol^-1 L^-2 cm^-2), detection limit (16.0 ± 0.8 pmol L^-1), and quantification limit (LOQ; 53.3 ± 1.5 pmol L^-1) in this observation. Considering the linear region in calibration plot, the linear dynamic range of 1,4-dioxane chemical sensor was found (0.12 nmol L^-1 ∼ 1.2 mmol L^-1). Besides this, the proposed 1,4-dioxane chemical sensor was exhibited good reproducibility, long-term stability, high accuracy in detecting of 1,4-dioxane in real environmental samples. This research is to develop of a selective and an efficient electrochemical sensor. It might be a simple and easy way by applying electrochemical method to ensure the safe and sustainable green environment.

Clinicopathological Study of Enterocutaneous Fistula in Mymensingh Medical College Hospital

Enterocutaneous fistulae are a major catastrophe to the patients and surgeons and it still has high incidence of morbidity and mortality and their management remains a big challenge. Enterocutaneous fistula presents the surgeon with challenges of metabolic disorders and extensive sepsis. Total management of an intestinal fistula requires skill in nutritional support, stoma therapy, elimination of sepsis, well timed and well carried out surgery. Postoperative enterocutaneous fistulae account for approximately 80% of enterocutaneous fistulae. The majority of the intestinal fistula (75-85%) is iatrogenic occurring in the postoperative period following anastomotic dehiscence. They arise following emergency abdominal surgery for intestinal obstruction, inflammatory bowel disease or cancers. Protein calorie malnutrition alters the patients immune response, inflammatory reactions and tissue regenerations, all of which are essential for wound repair. The present study is an effort to highlight the incidence of enterocutaneous fistula after emergency and elective resection and anastomosis of gut with discussion over recent trends and developments in its management and compare with other studies. Objectives of the study are to determine the various clinicopathological features and management protocol of enterocutaneous fistula. There are recent advances in nutritional support. This descriptive type of cross-sectional study was carried out in the Department of Surgery, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh from October 2010 to September 2011. Total 42 cases of enterocutaneous fistulae were selected purposively. Enterocutaneous fistulae are more common in patients of low economic condition. Enterocutaneous fistulae are more common after emergency abdominal surgery. Spontaneous closure occurred in 17(40.48%) cases and surgery needed in 25(59.52%) cases. Of them 20(80.00%) were healed and 5(20.00%) were expired. In spite of improvement in the management protocol of enterocutaneous fistula, there is still high unacceptable morbidity and mortality rate. Total parenteral nutrition (TPN) is not available and very costly, and health care facilities are also limited in our country. Patients with enterocutaneous fistula require fluid, electrolytes and nutritional support. Anaemia, dehydration, electrolytes imbalance should be corrected prior to abdominal surgery if possible. Surgical treatment for enterocutaneous fistula should be performed only after failure of conservative treatment of more than 12 weeks.

Association between Serum Apolipoprotein-B and Acute Ischaemic Stroke

Stroke is one of the leading causes of death and disability in developed as well as developing countries like Bangladesh. There is a crucial need to identify additional risk factors that are easily measurable and treatable in general population. Role of serum lipids, lipoproteins and lipoprotein related variables in the prediction of stroke is less clear. Abnormalities in plasma lipoproteins are the most firmly established and best understood risk factors for atherosclerosis and they are probable risk factors for ischaemic stroke, largely by their link to atherosclerosis. High serum apolipoprotein-B (Apo-B) levels may predict an increased risk for ischaemic stroke. Aim of the study was to evaluate the association between serum Apo-B level and acute ischaemic stroke and to measure and compare serum Apo-B level in ischaemic stroke and normal subjects. A cross-sectional comparative study was carried out in the department of Neurology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2013 to June 2015. A total number of 100 subjects within 18-70 years were considered for the study. Fifty (50) subjects with stroke (both clinically as well as CT scan of head or MRI of brain proven) were taken as the cases and 50 age and sex matched nearly healthy individuals without stroke were taken as the controls by using non-probability sampling procedure. Total cholesterol, HDL cholesterol and triglycerides were estimated by enzymatic method using Semiautoanalyser. LDL cholesterol was estimated by Friedewald formula. Apo-B was estimated by immunoturbidimetric method using Semiautoanalyser. Finally collected data were analyzed by using SPSS software Version 20. Student 't' test was used to compare the data between cases and controls. P value was set <0.05. Diagnostic validity tests were conducted to assess the diagnostic efficiency of Apo-B. Total cholesterol, LDL cholesterol and triglycerides are significantly increased in cases compared to controls. HDL-cholesterol was significantly decreased in cases compared to controls. Apo-B was significantly increased in cases compared to controls. The result was statistically significant. Apo-B may be used as predictors of ischaemic stroke components.

The Pattern of Serum Calcium, Phosphate and Parathyroid Hormone Levels in Pre-Diagnosed Chronic Kidney Disease Patients

Chronic kidney disease (CKD) is an international health problem affecting 5-10% of the world population. Patients with chronic kidney disease were known to have higher prevalence of changes in serum calcium, phosphate and parathyroid hormone in Western countries, but data on the impact of CKD on serum calcium, phosphate and parathyroid hormone in our country are scarce. This cross-sectional type of descriptive study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from March 2016 to September 2016. The aim of this study is to estimate serum calcium, phosphate and parathyroid hormone levels in chronic kidney disease (CKD) patients for early recognition of abnormalities, understanding of their patho-physiological consequences & planning management strategies to prevent their progression, thus reducing the morbidity & mortality. This study shows Hypocalcemia, hyperphosphataemia and elevated serum PTH levels are noted in later CKD stages & worsen with disease progression.

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

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

Impact of Adrenocortical Insufficiency on Clinical Parameters in Haemodynamically Stable Cirrhotic Patients with Ascites

Cirrhosis has many complications regardless of the aetiology. Complications include splenomegaly, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome and hepatocellular carcinoma and also linked to abnormalities in the endocrine system, including abnormal sex hormone metabolism, thyroid disease, osteoporosis, and, most recently identified, adrenal insufficiency. This prospective cohort study was done to evaluate the impact of adrenocortical insufficiency on clinical parameters in haemodynamically stable cirrhotic patients with ascites and had been performed at the inpatient of GHPD Department, BIRDEM, Dhaka, Bangladesh from April 2011 to March 2012. A total of fifty three (53) patients fulfilling inclusion criteria were included in the study. Patients were divided into two groups: Group A (patients of normal adrenal function) and Group B (patients of insufficient adrenal function) and those were followed up for the next 6 months. In Group A, the total number of patients was 25(47%) and in Group B it was 28(53%). Between two groups, mean age difference and gender difference were not statistically significant (p value was 0.278 and 0.933, respectively). Group B patients had significant higher CLD duration (p=0.004). Haematemesis and/or maelena was significantly lower in Group B at follow up (p=0.0001) due to significant higher number of band ligation in this group (p=0.009). Hepatic encephalopathy was significantly higher in Group B at enrollment (p=0.028) and at follow up (p<0.001). During the period of follow up, significant higher number of patients had developed hepatic encephalopathy in Group B compared to Group A (p<0.05). There was statistically significant higher number of patients had SBP (p=0.031) in Group B at follow up. During the period of follow up, only 1(4%) patient in Group A and 5(18%) patients in Group B died. There was no significant difference of number of death between two groups (p=0.196). Adrenal insufficient decompensated cirrhotic patients have higher morbidities.

Use of Acute Physiology and Chronic Health Evaluation (APACHE)-II and Red Cell Distribution Width (RDW) for Assessment of Mortality of Patients with Sepsis in ICU

Critically ill patients of Intensive Care Unit (ICU) need highest level of monitoring, intense nursing care and integrated management which are very expensive and consume significant part of hospital resources. Prediction of outcome from disease has become an essential component of health science. So, various scoring systems have been developed to predict outcome of critically ill patients in ICU. There is no perfect model of severity score to predict ICU mortality. Search for new system is still remaining as continuous efforts to find the best model to get accurate information about the prognosis and outcome of critically ill patients. This observational prospective cohort study was carried out in ICU of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2015 to September 2015 to evaluate the ability of mortality prediction of Acute Physiology and Chronic Health Evaluation (APACHE)-II after adding RDW. Total 62 patients, clinically diagnosed as sepsis with positive culture were included in this study after analyzing selection criteria. APACHE II score model was compared with APACHE II plus RDW score model in relation to mortality outcome assessment. Sensitivity, Specificity, Positive predictive value (PPV), Negative predictive value (NPV) and Receiver Operating Characteristic (ROC) curve were used as parameter to compare the predictive ability of the two models. The derived model APACHE II- RDW was found with higher predictive power (Pearson's correlation coefficient - 0.915) than APACHE II (Pearson's correlation coefficient - 0.885) in relation to mortality (p<0.01). Accuracy was compared by using Receiver Operating Characteristic (ROC) curve between the two models and AUROC was found higher (AUC-0.87) in case of new model compared with conventional model (AUC-0.85). So combination of RDW with APACHE-II increases the predictive ability of the scoring model in relation to mortality.

Detection of Zn2+ release in nitric oxide treated cells and proteome: dependence on fluorescent sensor and proteomic sulfhydryl groups

Nitric oxide (NO) is both an important regulatory molecule in biological systems and a toxic xenobiotic. Its oxidation products react with sulfhydryl groups and either nitrosylate or oxidize them. The aerobic reaction of NO supplied by diethylamine NONOate (DEA-NO) with pig kidney LLC-PK₁ cells and Zn-proteins within the isolated proteome was examined with three fluorescent zinc sensors, zinquin (ZQ), TSQ, and FluoZin-3 (FZ-3). Observations of Zn²⁺ labilization from Zn-proteins depended on the specific sensor used. Upon cellular exposure to DEA-NO, ZQ sequestered about 13% of the proteomic Zn²⁺ as Zn(ZQ)₂ and additional Zn²⁺ as proteome·Zn-ZQ ternary complexes. TSQ, a sensor structurally related to ZQ with lower affinity for Zn²⁺, did not form Zn(TSQ)₂. Instead, Zn²⁺ mobilized by DEA-NO was exclusively bound as proteome·Zn-TSQ adducts. Analogous reactions of proteome with ZQ or TSQ in vitro displayed qualitatively similar products. Titration of native proteome with Zn²⁺ in the presence of ZQ resulted in the sole formation of proteome·Zn-ZQ species. This result suggested that sulfhydryl groups are involved in non-specific proteomic binding of mobile Zn²⁺ and that the appearance of Zn(ZQ)₂ after exposure of cells and proteome to DEA-NO resulted from a reduction in proteomic sulfhydryl ligands, favoring the formation of Zn(ZQ)₂ instead of proteome·Zn-ZQ. With the third sensor, FluoZin-3, neither Zn-FZ-3 nor proteome·Zn-FZ-3 was detected during the reaction of proteome with DEA-NO. Instead, it reacted independently with DEA-NO with a modest enhancement of fluorescence.

Human virus and microbial indicator occurrence in public-supply groundwater systems: meta-analysis of 12 international studies

Groundwater quality is often evaluated using microbial indicators. This study examines data from 12 international groundwater studies (conducted 1992-2013) of 718 public drinking-water systems located in a range of hydrogeological settings. Focus was on testing the value of indicator organisms for identifying virus-contaminated wells. One or more indicators and viruses were present in 37 and 15% of 2,273 samples and 44 and 27% of 746 wells, respectively. Escherichia coli (E. coli) and somatic coliphage are 7-9 times more likely to be associated with culturable virus-positive samples when the indicator is present versus when it is absent, while F-specific and somatic coliphages are 8-9 times more likely to be associated with culturable virus-positive wells. However, single indicators are only marginally associated with viruses detected by molecular methods, and all microbial indicators have low sensitivity and positive predictive values for virus occurrence, whether by culturable or molecular assays, i.e., indicators are often absent when viruses are present and the indicators have a high false-positive rate. Wells were divided into three susceptibility subsets based on presence of (1) total coliform bacteria or (2) multiple indicators, or (3) location of wells in karst, fractured bedrock, or gravel/cobble settings. Better associations of some indicators with viruses were observed for (1) and (3). Findings indicate the best indicators are E. coli or somatic coliphage, although both indicators may underestimate virus occurrence. Repeat sampling for indicators improves evaluation of the potential for viral contamination in a well.

Impact of Adrenocortical Insufficiency on Biochemical Parameters in Haemodynamically Stable Cirrhotic Patients with Ascites

Cirrhosis has many complications regardless of the aetiology. Among them, adrenal insufficiency is recently identified entity. A prospective cohort study was done to evaluate the biochemical impact of adrenocortical insufficiency in haemodynamically stable, non-septic, cirrhotic patients with ascites and had been performed at the inpatient of GHPD department, BIRDEM, Dhaka from April 2011 to March 2012. A total of fifty three (53) patients fulfilling inclusion criteria were included in the study. Patients were divided into two groups: Group A (patients of normal adrenal function) and Group B (patients of insufficient adrenal function) and those were followed up for the next 6 months. In Group A, the total number of patients was 25(47%) and in Group B it was 28(53%). Between two groups, mean age difference and gender difference were not statistically significant. (p value was 0.278 and 0.933, respectively). At enrollment, there was significant lower mean Hb concentration in Group B (p=0.008). There was no significant difference of means of WBC count and platelet count between two groups (p value was 0.829 and 0.333, respectively). There were significant abnormalities in serum bilirubin, serum albumin, INR, SBP, HRS, Serum Na concentration, TCO2 concentration in Group B patients at follow up after 6 months. Adrenal insufficient decompensated cirrhotic patients have higher biochemical abnormalities, thus higher morbidities.

Cutaneous Histiocytic Sarcoma with Regional Lymph Node Metastasis in a Netherland Dwarf Rabbit (Oryctolagus cuniculus)

A 10-year-old male Netherland dwarf rabbit (Oryctolagus cuniculus) was presented with a red nodular mass (1 cm in diameter) with ulceration and hair loss in the skin of the left upper lip. Cytological examination revealed atypical round cells. The mass was excised surgically. Histologically, the mass was composed of large round to polyhedral neoplastic cells with marked cytological atypia. The neoplastic cells were often binucleated or multinucleated. Immunohistochemically, the neoplastic cells were intensely positive for Iba1 and vimentin, but fewer neoplastic cells expressed E-cadherin. Nuclear immunoreactivity for Ki67 was detected in approximately 41% of the neoplastic cells. Metastasis to the left cervical lymph nodes was detected 6 months after the surgical excision. Based on clinical, histopathological and immunohistochemical findings, the present case was diagnosed as cutaneous histiocytic sarcoma. To the authors' knowledge cutaneous histiocytic disease has not been reported previously in lagomorphs.

Selecting statistical model and optimum maintenance policy: a case study of hydraulic pump

Introduction

Proper maintenance policy can play a vital role for effective investigation of product reliability. Every engineered object such as product, plant or infrastructure needs preventive and corrective maintenance.

Case description

In this paper we look at a real case study. It deals with the maintenance of hydraulic pumps used in excavators by a mining company. We obtain the data that the owner had collected and carry out an analysis and building models for pump failures. The data consist of both failure and censored lifetimes of the hydraulic pump.

Discussion and evaluation

Different competitive mixture models are applied to analyze a set of maintenance data of a hydraulic pump. Various characteristics of the mixture models, such as the cumulative distribution function, reliability function, mean time to failure, etc. are estimated to assess the reliability of the pump. Akaike Information Criterion, adjusted Anderson–Darling test statistic, Kolmogrov–Smirnov test statistic and root mean square error are considered to select the suitable models among a set of competitive models. The maximum likelihood estimation method via the EM algorithm is applied mainly for estimating the parameters of the models and reliability related quantities.

Conclusions

In this study, it is found that a threefold mixture model (Weibull–Normal–Exponential) fits well for the hydraulic pump failures data set. This paper also illustrates how a suitable statistical model can be applied to estimate the optimum maintenance period at a minimum cost of a hydraulic pump.

Comparative Study between Pentoxifylline and Pioglitazone in the Treatment of Non-Alcoholic Fatty Liver Disease among Newly Detected Glucose Intolerant Patients

This quasi experimental study was carried out to compare the efficacy of Pentoxifylline versus Pioglitazone in non-alcoholic fatty liver disease (NAFLD) among newly detected glucose intolerant patients attended at GHPD, BIRDEM, Dhaka, Bangladesh from March 2011 to May 2012. Sixty patients with newly detected abnormal glucose tolerance, naive to any antidiabetic drugs were randomly selected, with the findings of USG changes of fatty liver and raised ALT. Patients were divided into Group A (51.7%; mean age - 44.45±7.34 years, BMI - 26.76±3.65kg/m(2)) receiving Pioglitazone 30mg/day and Group B (48.3%; mean age - 43.97±10.13 years, BMI - 27.52±4.44kg/m(2)) receiving Pentoxifylline 1200mg/day along with dietary and lifestyle modification. Baseline, follow up 1 & follow up 2: Serum AST in Group A (66.58±40.78U/L, 45.00±19.43U/L and 33.25±9.92U/L) respectively and in Group B (54.13±20.11U/L, 38.31±12.90U/L and 30.62±9.63U/L) respectively. Serum ALT in Group A (113.48±61.38U/L, 61.16±19.45U/L and 42.45±13.84U/L) respectively & in Group B (99.13±37.95U/L, 50.27±15.95U/L and 37.24±9.51U/L) respectively. No patient with normal USG finding was included in the study. Baseline USG finding: Grade I - Group A (35.5%), Group B (27.6%); Grade II - Group A (54.8%), Group B (48.3%); Grade III - Group A (9.7%), Group B (24.1%). Final Follow up: Normal - Group A (16.1%), Group B (10.3%); Grade I - Group A (38.7%), Group B (34.5%); Grade II - Group A (41.9%), Group B (44.8%); Grade III - Group A (3.2%), Group B (10.3%). Within groups findings were statistically significant (P<0.001) but between groups not significant (P>0.001). Biochemical and USG grading were improved in follow ups in both the groups. Such findings were observed due to synergistic effect of both therapeutic intervention along with supplementary dietary and lifestyle modification. Both Pioglitazone and Pentoxifylline have similar therapeutic outcome combined with supplementary dietary and lifestyle modification.

Biomass Fuel Smoke and Tuberculosis: A Case-Control Study

This case control study was done to ascertain the association between exposures to biomass cooking fuel smoke and pulmonary tuberculosis. Cases were all newly diagnosed pulmonary tuberculosis patients, randomly collected from the Hospital (DOTS centers) Registry from January 2012 to June 2012 from two Upazillas of Sirajganj district, Bangladesh. A home visitation program was done subsequently. Healthy controls were recruited from the neighbourhood of each case through a predefined procedure. Total 276 new pulmonary tuberculosis cases and 276 neighbourhood controls were enrolled. A semi-structured questionnaire containing demographic information, smoking habits, cooking place, kitchen condition, use of biomass fuel for cooking was used for interview. Crude (unadjusted) odd ratios and their corresponding 95% confidence limits for independent variables were determined by binary logistic regression. All significant variables were entered into a multivariate conditional logistic regression model and a final fitted model was determined by backward elimination methods. In univariate analysis, member of a nuclear family {Unadjusted odd ratio (Unadj. OR) 1.570, 95% CI 1.008-2.44)}, having non-formal education (Unadj. OR 2.739, 95% CI 1.219, 6.153) or primary (Unadj. OR 3.407, 95% CI 1.492, 7.782) to secondary level (Unadj. OR 2.392, 95% CI 1.032, 5.544) education, using cow dung (Unadj. OR 3.961, 95% CI 1.267, 12.376) and biomass fuel i.e. plant origin (Unadj. OR 3.382, 95% CI 1.087, 10.518) for cooking, past smoker (Unadj. OR 2.504, 95% CI 1.061, 5.910), using open oven (Unadj. OR 3.109, 95% CI 0.995, 9.716), having small kitchen area (Unadj. OR 0.99, 95% CI 0.989, 0.999) all were significantly associated with tuberculosis. When all significant variables were entered into a multivariate conditional logistic regression model nuclear family {Adjusted odd ratio (Adj OR) 1.808, 95% CI 1.127, 2.9)}, primary level education (Adj OR 2.86, 95% CI 1.23, 6.647) and non formal education (Adj OR 2.312, 95% CI 1.013, 5.276), biomass fuel (plant origin, Adj OR 3.497, 95% CI 1.059, 11.55), and cow dung (Adj OR 4.368, 95% CI 1.319, 14.464)) used in cooking and irregular smoker (who stop smoking at least 6 month back) (Adj OR 2.806, 95% CI 1.141, 6.901) were significantly associated with tuberculosis cases. From this study significant association have been found between exposure to combustion of biomass cooking fuel and tuberculosis.

Cognitive Functions and Health Related Quality of Life of Institutional Autism Spectrum Disorder Children in Dhaka city

In Bangladesh, nearly 10.5 hundred thousand individuals may have autism. Recent figures released by the CDC (2012) show that autism spectrum disorders (ASDs) now affect 1 in 88 children. Cognitive impairment, limited adaptive skills, and severe social impairment as seen in Autism Spectrum Disorders (ASD) thought to be associated with poorer health related quality of life (HRQoL). The objective of the study was to measure HRQoL and cognitive functioning in a group of autism Spectrum Disorder (ASD) children and to relate HRQoL with their socio demographic characteristics and cognitive functioning from parents' perception. This cross sectional study was conducted amongl49 purposively selected parents who have institutionalized autistic children (2 to 18 years old) from January to June 2013. HRQoL was assessed by Pediatric Quality of Life Inventory 4.0 (Vemil998) and cognitive functioning was assessed with The PedsQL TM Cognitive Functioning Scale. Three fourth of the children were male (n=-115, 77.2%) and the mean (SD) age of the children was 7.8(3.06) years. Symptoms of autism appeared at about their 2rd birthday 2.1 (.70) while the average (SD) age of diagnosis was around three years 2.9 (.98). The children were reported to go to school at an early age of 3(1.75) years. Out of 149 respondents, ten percent parents (n=14) had the history of consanguineous marriage. The sample data provides significant difference between the scores by the ability of verbal communication (p<.05), presence of autistic siblings (p<.05) and mother's occupation (p<.05). There found negative correlation between HRQoL and age of symptom appearance and cognitive functioning with age of diagnosis (r = - 0.18; p=.03). Cognitive functioning was strongly correlated with total PedsQL score and its domains (r = 0.73; p=.00). i.e. Higher cognitive function leads to good health related quality of life. Linear regression was performed to study the relationship between HRQoL and independent variables found significant in univariate analysis. The results of the regression indicated the predictors in the model explained 57 % of the variance (R2=.57, F=23.05, p<.001). It was found that fathers who were doctors and engineers by profession (t=2.34, p= .02), child's ability to communicate with words (t= 2.73, p= .007), age of symptom appearance (t= -2.71, p=.008), and cognitive functioning (t =12.28, p <0.001) significantly predicted HRQol of ASD children. Father's occupational status child's ability to communicate by word, age of symptom appearance, and Cognitive functioning of ASD children were found related to their quality of life.

Late lead Perforation Following Permanent Pace Maker Implantation--A Case report

Ventricular lead perforation is an infrequent but it's a critical complication of pacemaker implantation. Perforation was usually associated with the use of small-caliber active fixation leads, and can occur beyond the first few days (sub acute) or even more than a month after implantation (late). We report the case of right ventricular perforation by a ventricular fixation lead in 61 years old man detected more than two months after implantation. Radiology and echocardiography can confirm the perforation by revealing progression of the lead beyond the cardiac silhouette or indirectly visualizing the presence of pericardial effusion. However, its pathophysiology and optimal management are currently unclear.

Laser from Optically Pumped Quantum Dot CdSe/ZnS in a Colloidal Liquid

In this study, we had investigated the amplified spontaneous emission (ASE) characteristics of CdSe/ZnS quantum dot (QDs) in a colloidal liquid. A third harmonic of Nd:YAG laser (355 nm) was used to produce laser-induced fluorescence (LIF) at 605 nm with a spectral width of 0 nm [full width at half maximum (FWHM)]. When the pump power and focusing were carefully optimized, an ASE at 610 nm with a spectral width of Δλ = 8 nm (FWHM) could be obtained. The beam was directional with a divergence of 10 milli radians (mrad); but the conversion efficiency was about 0.05%.

Sociocultural and host factors related to extra-pulmonary tuberculosis in rural Bangladesh: A case control study

Bangladesh ranks sixth among higher TB burden countries. Extra-pulmonary TB contributes 12% of all tuberculosis cases in 2008. Risk factors for EPTB in Bangladesh are hypothesized to be different from pulmonary tuberculosis as seen in other high-burden countries. A case control study was conducted to compare the sociodemographic, household condition and lifestyle characteristics between extra pulmonary and pulmonary tuberculosis. This case control study was conducted in thirteen sub districts of Pabna, Shirajgonj and Cox's Bazar districts from January to June 2013. The samples were classified as either extra pulmonary tuberculosis EPTB (cases) or pulmonary tuberculosis PTB (controls). A total of 490 participants including 245 extra pulmonary tuberculosis (cases) and 245 pulmonary tuberculosis (controls), who were being enrolled in DOTS treatment for last six months, were interviewed for epidemiological and clinical information using a standardized questionnaire. Children, adolescent and younger adults had four-time higher risk of being manifested with extra pulmonary tuberculosis [Adjusted odds ratio (AOR) 3.97; 95% Confidence Interval (CI) 1.10 to 14.35] and (AOR 4.50; 95% CI 1.48 to 13.72). Respondents, who lived in their own houses showed three times more chance of getting extra pulmonary disease (AOR 3.11; 95% CI 1.15 to 8.39). Extra pulmonary tuberculosis was seven to eight times more likely to occur among those whose resided in bedrooms ventilated with one (p= .001) or more windows (p =.004) and having window shutter made of glasses or wood slit raised the probability of getting extra pulmonary involvement by twenty times. Households using grain husk and leaves as cooking fuel revealed seven times higher chance of being manifested as extra pulmonary tuberculosis (P <.001). Extra pulmonary cases were three times more common among respondents, who had no history of exposure with known tuberculosis cases than those who had frequent exposure history (AOR 3.01; 95% CI 1.24 to 7.34). Extra pulmonary tuberculosis was found 1.5 times more common among BCG vaccinated respondents than pulmonary tuberculosis (AOR 1.66; 95% CI 1.06 to 2.58). Younger age, house ownership, bedroom ventilation, fuel material used for cooking, contact history and BCG vaccination status might be the important risk factors for the extra pulmonary manifestation of tuberculosis relative to pulmonary tuberculosis.

Attitude and Practices of Mothers on Breastfeeding Attended at a Tertiary Hospital in Bangladesh

This descriptive cross sectional study was conducted in Pediatric Out Patient Department (OPD) of Mymensingh Medical College Hospital (MMCH) from November 2013 to April 2014 to assess the knowledge and practices of the mothers about breastfeeding. Four hundred mothers having children 6 months to 2 years of age attended at OPD of MMCH for any cause were included in the study by systematic random sampling. A structured, pre-tested, interview schedule was used to collect data from mothers. All mothers were continuing to breastfeed their children. Two hundred and seventy-two (68.00%) infants received breast feeding within 1 hour after birth, while 128(32.00%) infants received breast feeding after 1 hour of birth. Of 128, in 48(37.50%) cases, mother's illness was the reason for delay in initiation of breast feeding, whereas in 70(54.69%) cases, it was due to reduced milk production on mother's statement. Pre-lacteal feeding was given in 96(24.00%) children. Among them honey was given in 24(25.00%) cases, cow's milk was given in 14(14.58%) cases, sugar water was given in 18(18.75%) cases and formula milk was given in 40(41.67%) cases. One hundred and twenty-eight (32.00%) mothers started to give their child food other than breast milk before 3 months of age and 148(37.00) mothers started to give their child food other than breast milk before 6 months of age. The reason for starting to give their child food other than breast milk before 6 months of age was mother's assumption of milk insufficiency in 166(60.14%) cases and baby's cry for hunger in 110(39.86%) cases. Formula milk was given in 120(30.00%) infants before 6 months of age. Among them 96(80.00%) mothers prepared it with larger amount of water. Plain water was given in 240(60.00%) children before the age of 6 months. One hundred and twenty-four (31.00%) children were exclusively breastfeed for first 6 months of age. Breastfeeding is almost universal in Bangladesh but the exclusive breastfeeding rate is alarmingly very low. Great emphasis is needed to educate mothers about benefits of colostrum, exclusive breastfeeding, and the harmful effects of pre-lacteal feeding.