Effectiveness of Standard Treatment Outcome for Different Stages of Chronic Obstructive Pulmonary Disease Patients: Role of 6 Minute Walk Test

ABSTRACTBackground: Chronic Obstructive Pulmonary Disease (COPD)is defined as a avertible and curable disease characterized by“persistent airflow limitation” that is usually advanced andassociated with an heightened chronic inflammatory responsein the airways, and the lung tonoxious particles or gases.Habitual smoking of cigarette represents the most significantrisk for impeding COPD, as well as low birth weight, recurrentinfections, indoor air pollution with biomass fuel, low socioeconomic status, occupational exposure such as xoal dust,silica, cadmium etc, Different stages of COPD based on postbronchodilator FEV1, in patients with FEV1/FVC <0.70.Aim: To find out the effectiveness of the combined treatmentoutcomes by studying the patients with different stages ofseverity of Chronic Obstructive Pulmonary Disease.Methods: A Prospective study was carried out during theperiod from 1stJune 2018 to 31st December 2018 in theoutpatients department (OPD) of Patuakhali 250 Bed SadarHospital, Patuakhali. One Hundred and Fifty COPD patientswere included in this study. The study was conducted bymeasuring the response of patients with by following the “6Minute Walk Test” or

High fluoride and low pH level have been detected in popular flavoured beverages in Malaysia

In children, excessive ingestion of fluoride from different sources including bottled drinking water and flavoured beverages or soft drinks can lead to the development of dental fluorosis. In addition, the pH level of beverages is important. Low pH can cause dental erosion. In this study we explore the fluoride content and pH level of certain popular beverages available in Malaysian supermarkets and hawkers' stalls. Bottled drinking water and selected popular flavoured packet drinks were purchased from a supermarket and the corresponding flavoured hawkers' drinks, from a hawker's stall in Kuala Lumpur. Fluoride and pH of the beverages were determined using digital fluoride meter and digital pH meter respectively. It was found that fluoride content and pH level vary among the beverages. The mean fluoride content in both packet and hawkers' drinks [7.64 +/- 1.88 mg/L, 7.51 +/- 1.60 mg/L, respectively] was approximately 7 times higher than the bottled drinking water [1.05 +/- 0.35 mg/L]. Among the beverages, the tea packet drink was found to contain the highest amount of fluoride [13.02 +/- 0.23 mg/L]. The mean pH of bottled-drinking water was near neutral [6.96 +/- 0.17], but acidic for both supermarket [4.78.00 +/- 0.49] and hawkers' drinks [5.73 +/- 0.24]. The lychee packet drink had the lowest pH level [2.97 +/- 0.03]. Due to the wide variation of the fluoride content and pH level of the drinks tested in this study, it is recommended that steps should be taken to control the fluoride concentration and pH level in beverages if dental fluorosis and erosion are to be prevented

Polycystic ovarian syndrome in women with acne

Acne is a common manifestation of hyperandrogenemia. Polycystic ovarian syndrome [PCOS] is a common endocrine abnormality affecting reproductive aged women. In the female, the most common cause of hyperandrogenemia is PCOS. The purpose of our study was to determine the PCOS in women with acne. In this observational, cross sectional study, 40 females, aged 15-40 years, with various degree of acne who had not received hormonal treatment, including hormonal contraceptive and antiandrogen therapy, for at least 3 months prior to study and 30 female volunteers [aged 15-40 years] without acne or acne scars were enrolled as controls. The severity of acne was graded as mild, moderate or severe. Clinical data including age, weight, height, body mass index [BMI], menstrual history and androgenic sign [hirsutism, alopecia, acanthosis nigricans] were recorded and hormonal assays and pelvic ultrasonography were done. Clinical parameters [acne with menstrual irregularity] accompanied by other features of hyperandrogenism and/or elevated level of luteinizing hormone [LH] to follicle-stimulating hormone [FSH] ratio and/or ultrasound picture based upon the presence of multiple small subcapsular cysts [diameter 2-8 mm] with dense echogenic stroma, were used to diagnose PCOS. 7.5% patients were obese in case group, which was statistically significant. No statistically significant differences were observed in hormonal profiles [serum LH and serum FSH] but significant differences seen in serum testosterone level and pelvic ultrasound to visualize the polycystic ovary in women with acne. There were 11 [27.5%] women with PCOS among the 40 women with acne; 8 showed PCO picture on ultrasound. 10 cases with elevated LH to FSH ratio. Out of 11 women with PCOS, 1 case was diagnosed only clinically. Control group had also one PCOS [3.3%]. Prevalence of PCOS with acne was higher in studied cases than control group, which is statistically significant in our population. All women with acne should be considered for underlying PCOS and asked about their menstrual patterns and examined for other sign of hyperandrogenism. Those who have menstrual disturbances should have hormonal profile determination as well as pelvic ultrasonography for ovarian visualization. Early diagnoses and treatment can avoid the possible complications

Heavy metals contamination in water and sediments of an urban river in a developing country

Water and sediment samples were collected from 20 location of the Buriganga river of Bangladesh during summer and winter 2009 to determine the spatial distribution, seasonal and temporal variation of different heavy metal contents. Sequential extraction procedure was employed in sediment samples for the geochemical partitioning of the metals. Total trace metal content in water and sediment samples were analyzed and compared with different standard and reference values. Concentration of total chromium, lead, cadmium, zinc, copper, nickel, cobalt and arsenic in water samples were greatly exceeded the toxicity reference values in both season. Concentration of chromium, lead, copper and nickel in sediment samples were mostly higher than that of severe effect level values, at which the sediment is considered heavily polluted. On average 72% chromium, 92% lead, 88% zinc, 73% copper, 63% nickel and 68% of total cobalt were associated with the first three labile sequential extraction phases, which portion is readily bioavailable and might be associated with frequent negative biological effects. Enrichment factor values demonstrated that the lead, cadmium, zinc, chromium and copper in most of the sediment samples were enriched sever to very severely. The pollution load index value for the total area was as high as 21.1 in summer and 24.6 in winter season; while values above one indicates progressive deterioration of the sites and estuarine quality. The extent of heavy metal pollution in the Buriganga river system implies that the condition is much frightening and may severely affect the aquatic ecology of the river

Geochemical distribution of trace metal pollutants in water and sediments of downstream of an urban river

A study was conducted to investigate the trace metal pollution of water and sediments of downstream of Tsurumi River, Yokohama, Japan. Twenty samples of water and sediments were collected from the river starting from Tokyo bay side up to the junction point of the Yagami River, Results show that the mean concentrations of chromium, copper and nickel in water greatly exceed [>100 times] the surface water standard, The concentration of molybdenum and lead was also higher than standard values while iron and manganese was lower than that of surface water standard. The mean concentration of zinc, cupper, cadmium, lead, chromium, vanadium, bromine and iodine was 381,1, 133,0, 1.0,40.8, 102.9, 162.0, 71.5 and 10.6 microg/g sediments, respectively and was greatly exceed the average worldwide shale concentrations and average Japanese river sediment values. However, mean concentration of arsenic, nickel and strontium was 11.0, 36,6 and 164.6 microg/g sediments, respectively which was lower than the average shale value. Other analyzed trace metals, including barium, zirconium, rubidium, yttrium, tin, antimony, cesium, lanthanum, cerium, praseodymium and neodymium were detected in river sediments; the concentration of which was close to the Japan's river sediment average values. Pollution load index values of the sites of the studied area ranged from 1.24 to 7.65 which testify that the river sediments are polluted. The PLI value of the area was, however, high [6.53] as the concentration of trace metals like zinc, copper, cadmium, lead and chromium were very high and were the major pollutants

Inguinal hernia repair; experience of laparoscopic total extaperitoneal approach

To evaluate early results of laparoscopic repair of inguinal hernia by totally extraperitoneal approach [TEP] performed. At Surgical unit III, Jinnah hospital Lahore. From August 2005 to July 2008. 97 patients over the age of 30 years underwent TEP repair of their inguinal hernia. Post operative assessment of the patients included pain score assessment and analgesia requirement, along with ability to walk upright comfortably, time taken to return to normal activity and early complications like seroma, haematoma, infection etc. Post-operative pain assessment at 8 hours after surgery showed 43[44.3%] patients required extra analgesia while 24 hours after surgery only 13[13.4%] patients required extra analgesia. Mean operative time was 95 min [range 55-130min] for unilateral hernia. However, as experience increased with TEP repair, mean operating time decreased to 75mins in the second half of the cases. 21[20.6%] patients at 24hrs and 51[52.6%] patients at 48hrs could walk upright without any help. Median period for return to normal activity at domestic level was 5days [range 3-23].Incidence of early complications is shown in table-Ill. Our results of TEP laparoscopic hernia repair are comparable to European experience in terms of postoperative pain, mobility of patient and rehabilitation, as well as early complications