Durability performance of alkali-activated concrete with pre-treated coarse recycled aggregates for pavements.

This study examines the effect of coarse recycled aggregates (CRAs) and processed coarse recycled aggregates (PCRAs) on the behaviour of alkali-activated concrete (AAC) before and after exposure to marine seawater and acidic environments (5% HCl and 5% H2SO4 solutions). Measurements of compressive strength and the microstructure changes were conducted over periods of 56 and 90 days to assess these effects. The experimental design included varying the replacement levels of NAs with CRAs and PCRAs from (0-100%) and using ground-granulated blast furnace slag and fly ash as constant components. In addition to durability tests, sorptivity assessments were conducted to gauge the material's porosity and water absorption capabilities. Advanced microstructure techniques, such as scanning electron microscopy (SEM) and X-ray diffraction (XRD), were employed to detail the pre and post-exposure mineralogical and microstructural transformations within the AAC blends. The AAC mixtures incorporating PCRAs emerged as durable, showcasing better strength and a denser, more compact matrix facilitated by the synergistic formation of NASH and CASH gels after exposure to aggressive agents compared to untreated CRAs. In addition, the results show that the samples exposed to marine seawater exhibited improved mechanical performance compared to those exposed to acidic environments. The novelty of this study lies in its exploration of the effects of recycling plant-based CRAs and PCRAs on AAC for marine and acid exposure.

Development of Robust Freeze-Drying Process for Long-Term Stability of rVSV-SARS-CoV-2 Vaccine.

The thermostability of vaccines, particularly enveloped viral vectored vaccines, remains a challenge to their delivery wherever needed. The freeze-drying of viral vectored vaccines is a promising approach but remains challenging due to the water removal process from the outer and inner parts of the virus. In the case of enveloped viruses, freeze-drying induces increased stress on the envelope, which often leads to the inactivation of the virus. In this study, we designed a method to freeze-dry a recombinant vesicular stomatitis virus (VSV) expressing the SARS-CoV-2 spike glycoprotein. Since the envelope of VSV is composed of 50% lipids and 50% protein, the formulation study focused on both the protein and lipid portions of the vector. Formulations were prepared primarily using sucrose, trehalose, and sorbitol as cryoprotectants; mannitol as a lyoprotectant; and histidine as a buffer. Initially, the infectivity of rVSV-SARS-CoV-2 and the cake stability were investigated at different final moisture content levels. High recovery of the infectious viral titer (~0.5 to 1 log loss) was found at 3-6% moisture content, with no deterioration in the freeze-dried cakes. To further minimize infectious viral titer loss, the composition and concentration of the excipients were studied. An increase from 5 to 10% in both the cryoprotectants and lyoprotectant, together with the addition of 0.5% gelatin, resulted in the improved recovery of the infectious virus titer and stable cake formation. Moreover, the secondary drying temperature of the freeze-drying process showed a significant impact on the infectivity of rVSV-SARS-CoV-2. The infectivity of the vector declined drastically when the temperature was raised above 20 °C. Throughout a long-term stability study, formulations containing 10% sugar (sucrose/trehalose), 10% mannitol, 0.5% gelatin, and 10 mM histidine showed satisfactory stability for six months at 2-8 °C. The development of this freeze-drying process and the optimized formulation minimize the need for a costly cold chain distribution system.

Functional Assessment of Stable Chronic Obstructive Pulmonary Disease Patients Using Squat-to-stand Test.

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease of airflow limitation that is not fully reversible. COPD affects the lungs and produces significant systemic consequences. In Bangladesh, the prevalence of COPD after 40 years of age is 21.24% and the general population is 4.3%. COPD leads to a sedentary life, which reduces the functional status of the individual. Functional status assessment is vital for appropriate therapy and rehabilitation programs in COPD patients. A Sit-to-stand test (STST) has been proposed as a better alternative to 6MWT, but a Squat-to-stand test (SqTST) to test their ability to stand from the squatting position will be more appropriate in rural patients. This study was conducted using a cross-sectional observational design from July 2020 and September 2021 in the Department of Respiratory Medicine at the National Institute of Diseases of the Chest and Hospital, Bangladesh. Sixty (60) diagnosed cases of COPD patients were enrolled in this study. Severities of airflow obstruction according to GOLD were categorized on the basis of post-bronchodilator FEV1 by spirometry. SqTST was performed on all patients, and functional status was recorded. All data were collected using a preformed questionnaire. Statistical analyses of the findings were carried out using SPSS version 23.0. In this study, the majority of 21(35.0%) patients had very severe COPD, and almost half (48.3%) of the patients had abnormal SqTST. A significant relation was found between the severity of COPD with SqTST (p=0.001). Based on the receiver-operator characteristic (ROC) curve, SqTST had an area under curve 0.901. SqTST had 82.1% sensitivity, 85.7% specificity, 83.3% accuracy, 91.4% positive predictive value, and 72.0% negative predictive value to find severe COPD cases in stable COPD patients. ROC was constructed using SqTST, which gave a cut-off value <7.0, with 82.1% sensitivity and 85.7% specificity for predicting severe COPD. From this study, it may be concluded that SqTST is a clinically useful tool to assess the functional status of stable COPD patients.

COVID-19 outbreak in Bangladesh and associated psychological problems: An online survey.

Bangladesh is now experiencing the COVID-19 outbreak; however, there has been minimal focus on mental health over physical health problems during this pandemic in Bangladesh. The present study was conducted using self-rated scales on a sample of 500 Bangladeshi people to address this gap. Results suggested two-fifths of the participants had depression and anxiety symptoms, and one-third were highly worried and felt stressed. Females, students, unmarried, and 18-30-year-olds were in more vulnerable positions in terms of their mental health. These findings would be helpful to assess and formulate psychological interventions to improve the mental health of vulnerable groups.

Early TB case detection by community-based mobile X-ray screening and Xpert testing in Balochistan.

SETTING: This survey was conducted at 35 sites of 20 cities in 15 districts with low programmatic TB case notifications in the past years in Balochistan. OBJECTIVE: To assess the effectiveness of the systemic community-based screening and diagnosis for early detection of TB; and 2) to describe the characteristics and understand the strengths and weaknesses of the intervention in Balochistan, and sociodemographic factors associated with it. DESIGN: This cross-sectional descriptive study was conducted using a mobile van equipped with a digital X-ray machine with computer-aided detection for TB (CAD4TB) software for screening, followed by confirmatory high sensitivity Xpert® MTB/RIF assay testing. RESULTS: A total of 236 (3.4%) TB cases was detected out of 6,899 screened. About 1,168 (17%) presumptive TB cases were identified and 1,065 (91%) sputum samples were tested on Xpert. Among those diagnosed, 166 (70%) were Mycobacterium tuberculosis-positive and 70 (30%) were with clinical suspicion. Of the sputum samples tested, 87% (923/1065) had a probability score of >70 on CAD4TB. CONCLUSION: Community-based screening with innovative activities, comprising sensitive screening and diagnostic tools, effectively improves TB case detection, which might suffice to reduce the prevalence of TB and break the chain of infection transmission in the at-risk population.

CADRE: Cette enquête a été menée dans 35 sites de 20 villes dans 15 districts au Baloutchistan où le nombre de notifications de cas de TB était faible au cours des dernières années. OBJECTIVE: 1) Évaluer l'efficacité du dépistage et du diagnostic systémiques communautaires pour la détection précoce de la TB ; et 2) décrire les caractéristiques et comprendre les forces et les faiblesses de l'intervention au Baloutchistan, ainsi que les facteurs sociodémographiques qui y sont associés. MÉTHODE: Cette étude descriptive transversale a été menée à l'aide d'une camionnette mobile équipée d'un appareil à rayons X numérique avec logiciel de détection assistée par ordinateur pour la dépistage de la TB (CAD4TB), suivi d'un test de confirmation à haute sensibilité, l'Xpert® MTB/RIF. RÉSULTATS: Sur les 6 899 dépistés, 236 (3,4%) cas de TB a été détecté. Environ 1 168 (17%) cas présumés de TB ont été identifiés et 1 065 (91%) échantillons de crachats ont été testés avec Xpert. Parmi les cas diagnostiqués, 166 (70%) étaient positifs à Mycobacterium tuberculosis et 70 (30%) avaient une suspicion clinique. Parmi les échantillons de crachats testés, 87% (923/1 065) avaient un score de probabilité de >70 en CAD4TB. CONCLUSION: Le dépistage communautaire avec des activités innovantes, comprenant des outils de dépistage et de diagnostic sensibles, améliore efficacement la détection des cas de TB, ce qui pourrait suffire à réduire la prévalence de la TB et à rompre la chaîne de transmission de l'infection dans la population à risque.

Development of novel MnO2 coated carbon felt cathode for microbial electroreduction of CO2 to biofuels.

Fabrication of superior and cost-effective cathodic materials is vital in manufacturing sustainable microbial electrolysis cells (MECs) for biofuels production. In the present study, a novel manganese dioxide (MnO2) coated felt cathode (Mn/CF) has been developed for MECs using electrodeposition method via potentiostat. MnO2 is considered to encourage exogenous electron exchange and, in this way, improves the reduction of carbon dioxide (CO2). MnO2, as a cathodic catalyst, enhances the rate of biofuel production, electron transfer, and significantly reduces the cost of MECs. A maximum stabilized current density of 3.70 ±â€¯0.5 mA/m2 was obtained in case of MnO2-coated Mn/CF based MEC, which was more than double the non-coated carbon felt (CF) cathode (1.70 ±â€¯0.5 mA/m2). The dual chamber Mn/CF-MEC achieved the highest production rate of acetic acid (37.9 mmol/L) that was significantly higher (43.0%) in comparison to the non-coated CF-MEC. The cyclic voltammograms further verified the substantial enhancement in the electron transfer between the MnO2 coated cathode and microbes. The obtained results demonstrate that MnO2 interacted electrochemically with microbial cells and enhanced the extracellular electron transfer, therefore validating its potential role in biofuel production. The MnO2 coated CF further offered higher electrode surface area and better electron transfer efficiency, suggesting its applicability in the large-scale MECs.

Assessing risk to human health for heavy metal contamination through street dust in the Southeast Asian Megacity: Dhaka, Bangladesh.

Contaminants in road dusts can directly pose significant human health risks through oral ingestion, particle inhalation, and dermal contact. Therefore, this study has been designed to analyze heavy metal contaminations in 88 street dusts collected from the 22 high traffic sites and industrial areas of the Southeast Asian Megacity: Dhaka (capital of Bangladesh) using energy dispersive X-ray fluorescence (EDXRF) spectroscopy. This study revealed that the maximum Pb, Cd, Zn, Cr, Ni, As, Mn and Cu contents in the street dust samples were 18.9, 11.6, 239.2, 144.3, 37.1, 8.1, 261.5 and 49.6 mg/ kg respectively in which Ni and Pb concentration were 2 times, and Cd concentration was 200 times higher than the background level in soil; and As concentration was slightly higher than soil background level. The spatial distribution of heavy metal concentrations in street dust samples in Dhaka City was revealed that the hot spot areas of Pb, Ni, Cd and As were mainly associated with heavy traffic and industrial activities. The risk assessment strategies were used for this study for identifying the routes of exposure through oral ingestion, inhalation, and dermal contact by the fine particles (~75 µm) of street dust, especially for children based on the US EPA health risk models. Both non-carcinogenic and carcinogenic risks of heavy metals were characterized in street dust samples. Results based on the hazard index (HI), in the case of non-cancer effect, the ingestion of dust particles of children and adults in Dhaka City appeared to be the route of exposure to street dust that results in a higher risk for heavy metals, followed by dermal contact. This study revealed that the inhalation of re-suspended particles through mouth and nose were almost negligible. It was also noticed that children were experiencing the potential health risk due to HI for Cr (1.04), which was slightly higher than the safe level 1, and Cd (0.69) was close to the safe level 1. Reversely, cancer risk for Cr (i.e. 4.27 × 10-6) was fallen within the range of threshold values (10-4 to 10-6) and As (i.e. 9.59 × 10-7) was close to the upper limit of threshold values (10-4 to 10-6).

Validation of smear-positive tuberculosis diagnoses in Bangladesh.

SETTING: Questions have been raised as to the accuracy of smear-positive tuberculosis (TB) diagnoses at DOTS centres in Bangladesh. OBJECTIVE: To assess the validity of diagnoses by smear microscopy at 62 DOTS centres in various health facilities. DESIGN: Using a cross-sectional study design, smear-positive TB cases were included from high, medium and low-performing DOTS centres from July to December 2010. The centres were categorised according to their case detection rate: centres with case detection rates of >70%, 50-70% and <50% were classed as high, medium and low-performing, respectively. Microscopy was performed on spot and early morning sputum samples for all cases. RESULTS: A convenience sample of 333 recently diagnosed smear-positive TB cases was included. The average number of patients enrolled per centre was 5.4; the highest number of cases was diagnosed from low-performing DOTS centres. Of the 333 cases, 302 (90.7%) were confirmed, while 31 (9.3%) were smear-negative. CONCLUSION: Differences in microscopy results could be due to the poor quality of the sputum sample, of smearing, staining or reading, or erroneous reporting by the DOTS centres. Preset programme targets and the nationwide drug stockout may have led to overreporting by the DOTS centres.

The Duke Elder lecture: the challenge of equitable eye care in Pakistan.

PURPOSE: Pakistan, like many other developing countries, is caught in the vicious cycle of poverty, illiteracy, violence, and disease. Right from its inception, it has been facing serious challenges of fast growing population, longevity, unemployment, wars, floods, double burden of diseases including blindness, as well as earthquakes, insurgencies, and political instability. Despite such challenges, the country has managed to reduce the burden of blindness from 1.78% in 1987-88 to 0.9% in 2003.This paper will highlight the methods used to achieve such a difficult goal. METHODS: The country used the report of the World Health Organization (WHO) temporary consultant as the initial tool for advocacy to obtain political and professional commitment. Results from the first National Blindness Survey 1987-1990 were used as baseline for development of the programme. Under the Ministry of Health, national and provincial committees with respective coordinators were constituted. To ensure access and equity, the national programme was developed on the basis of district comprehensive eye care services. The concept was carefully tested in a laboratory and then piloted in a real district before it was rolled over to the country. Strong national institutes for human resource development, research and development, and service delivery were established. A strong network of high-quality national institutes was set up and run by powerful national non-governmental organizations. The second National Blindness Survey evaluated the achievements of the programme in 2001-2003. CONCLUSION: National prevalence of blindness was reduced by 100% by improving the uptake of services at the district level, especially by females.

Endophthalmitis: magnitude, treatment and visual outcome in northwest frontier province of Pakistan.

BACKGROUND: Many cases of post-operative and posttraumatic endophthalmitis are being managed at the Khyber Institute of Ophthalmic Medical Sciences, Peshawar in Pakistan but no study has been done to ascertain the magnitude of the disease and to also evaluate the visual outcome after management. METHODS: The case notes of 39 patients diagnosed with posttraumatic and postoperative endophthalmitis between May 2006 and April 2007 were analyzed and clinical characteristics obtained were documented and tabulated. RESULTS: During the study period, 2474 patients were admitted in both the male and female wards. Of these, 39 (1.6%) had endophthalmitis due to surgical and traumatic complications. In all, 6 (12.4%) patients had evisceration, while 21 (53.8%) patients who had topical antibiotics consisting of ofloxacin, 0.1% corticosteroids, fortified cetazoline and 1% atropine along with intravitreal antibiotics, a combination of 0.1 mg vancomycin and 0.4 mg amikacin, were discharged home with a visual acuity of counting fingers to light perception. CONCLUSION: Endophthalmitis is a serious ocular complication of open globe injury and intraocular surgery. The frequency in this center has been noted to be very high as compared to other places. Its management is very challenging and often leads to devastating structural and functional damage to the eye; causing severe frustration to both the patient and the attending physician. Efforts must be made to prevent the condition.

A review of 50 cases of aphakic detachment in Peshawar, North West Frontier Province of Pakistan.

BACKGROUND: This prospective study was conducted at Khyber Teaching Hospital Peshawar, North West Frontier Province (NWFP) of Pakistan over the period of 16 months. It was to assess the demographic pattern, mode of presentation, treatment modalities and postoperative result of aphakic retinal detachment. This study also compared the incidence of aphakic retinal detachment in intracapsular versus extracapsular cataract extraction as well as the duration between cataract surgery and retinal detachment. PATIENTS AND METHOD: A total of 50 patients were recruited in this prospective study. A Proforma was specially designed for this purpose. Detailed history with reference to age, sex, presenting complaints, spectacle wear, previous ocular surgery, duration of surgery/laser treatment, systemic and family history was taken. All patients had detailed ophthalmic examination, underwent conventional retinal reattachment surgery, and were followed up for 6 months. RESULTS: Of the total number studied, 86% of the patients were males; only 14% were females, with a mean age of 58 years. The overall anatomical success was achieved in 40 (80%) eyes. The visual acuity of 6/12 and better was achieved in 8 (16%) eyes. 20 (40%) eyes attained a vision of 6/18 to 6/36. 12 (24%) eyes had a vision between 6/60 to CF 3m. The vision could not be improved beyond CF 3m in 10 (20%) eyes. CONCLUSION: Vitreous loss during cataract surgery is the most common cause of aphakic retinal detachment. The risk is maximal in the first and second year. The overall anatomical attachment achieved through conventional retinal detachment surgery is 80%.

Poverty and blindness in Pakistan: results from the Pakistan national blindness and visual impairment survey.

OBJECTIVE: To explore the association between blindness and deprivation in a nationally representative sample of adults in Pakistan. DESIGN: Cross sectional population based survey. SETTING: 221 rural and urban clusters selected randomly throughout Pakistan. PARTICIPANTS: Nationally representative sample of 16 507 adults aged 30 or above (95.3% response rate). MAIN OUTCOME MEASURES: Associations between visual impairment and poverty assessed by a cluster level deprivation index and a household level poverty indicator; prevalence and causes of blindness; measures of the rate of uptake and quality of eye care services. RESULTS: 561 blind participants (<3/60 in the better eye) were identified during the survey. Clusters in urban Sindh province were the most affluent, whereas rural areas in Balochistan were the poorest. The prevalence of blindness in adults living in affluent clusters was 2.2%, compared with 3.7% in medium clusters and 3.9% in poor clusters (P<0.001 for affluent v poor). The highest prevalence of blindness was found in rural Balochistan (5.2%). The prevalence of total blindness (bilateral no light perception) was more than three times higher in poor clusters than in affluent clusters (0.24% v 0.07%, P<0.001). The prevalences of blindness caused by cataract, glaucoma, and corneal opacity were lower in affluent clusters and households. Reflecting access to eye care services, cataract surgical coverage was higher in affluent clusters (80.6%) than in medium (76.8%) and poor areas (75.1%). Intraocular lens implantation rates were significantly lower in participants from poorer households. 10.2% of adults living in affluent clusters presented to the examination station wearing spectacles, compared with 6.7% in medium clusters and 4.4% in poor cluster areas. Spectacle coverage in affluent areas was more than double that in poor clusters (23.5% v 11.1%, P<0.001). CONCLUSION: Blindness is associated with poverty in Pakistan; lower access to eye care services was one contributory factor. To reduce blindness, strategies targeting poor people will be needed. These interventions may have an impact on deprivation in Pakistan.

Cataract prevalence, cataract surgical coverage and barriers to uptake of cataract surgical services in Pakistan: the Pakistan National Blindness and Visual Impairment Survey.

AIM: To estimate the prevalence of visual impairment and blindness caused by cataract, the prevalence of aphakia/pseudophakia, cataract surgical coverage (CSC) and to identify barriers to the uptake of cataract services among adults aged >or=30 years in Pakistan. METHODS: Probability proportional-to-size procedures were used to select a nationally representative sample of adults. Each subject underwent interview, visual acuity measurement, autorefraction, biometry and ophthalmic examination. Those that saw <6/12 in either eye underwent a more intensive examination procedure including corrected visual acuity, slit lamp and dilated fundus examination. CSC was calculated for different levels of visual loss by person and by eye. Individuals with <6/60 in the better eye as a result of cataract were interviewed regarding barriers. RESULTS: 16 507 Adults were examined (95.5% response rate). The crude prevalence of blindness (presenting <3/60 in the better eye) caused by bilateral cataract was 1.75% (95% CI 1.55%, 1.96%). 1317 Participants (633 men; 684 women) had undergone cataract surgery in one or both eyes, giving a crude prevalence of 8.0% (95% CI 7.6%, 8.4%). The CSC (persons) at <3/60, <6/60 and <6/18 were 77.1%, 69.3% and 43.7%, respectively. The CSC (eyes) at <3/60, <6/60 and <6/18 were 61.4%, 52.2% and 40.7%, respectively. Cost of surgery (76.1%) was the main barrier to surgery. CONCLUSION: Approximately 570 000 adults are estimated to be blind (<3/60) as a result of cataract in Pakistan, and 3,560000 eyes have a visual acuity of <6/60 because of cataract. Overall, the national surgical coverage is good but underserved populations have been identified.

Causes of blindness and visual impairment in Pakistan. The Pakistan national blindness and visual impairment survey.

OBJECTIVE: To determine the causes of blindness and visual impairment in adults (> or =30 years old) in Pakistan, and to explore socio-demographic variations in cause. METHODS: A multi-stage, stratified, cluster random sampling survey was used to select a nationally representative sample of adults. Each subject was interviewed, had their visual acuity measured and underwent autorefraction and fundus/optic disc examination. Those with a visual acuity of <6/12 in either eye underwent a more detailed ophthalmic examination. Causes of visual impairment were classified according to the accepted World Health Organization (WHO) methodology. An exploration of demographic variables was conducted using regression modeling. RESULTS: A sample of 16 507 adults (95.5% of those enumerated) was examined. Cataract was the most common cause of blindness (51.5%; defined as <3/60 in the better eye on presentation) followed by corneal opacity (11.8%), uncorrected aphakia (8.6%) and glaucoma (7.1%). Posterior capsular opacification accounted for 3.6% of blindness. Among the moderately visually impaired (<6/18 to > or =6/60), refractive error was the most common cause (43%), followed by cataract (42%). Refractive error as a cause of severe visual impairment/blindness was significantly higher in rural dwellers than in urban dwellers (odds ratio (OR) 3.5, 95% CI 1.1 to 11.7). Significant provincial differences were also identified. Overall we estimate that 85.5% of causes were avoidable and that 904 000 adults in Pakistan have cataract (<6/60) requiring surgical intervention. CONCLUSIONS: This comprehensive survey provides reliable estimates of the causes of blindness and visual impairment in Pakistan. Despite expanded surgical services, cataract still accounts for over half of the cases of blindness in Pakistan. One in eight blind adults has visual loss from sequelae of cataract surgery. Services for refractive errors need to be further expanded and integrated into eye care services, particularly those serving rural populations.

Cataract blindness and visual outcome of cataract surgery in a tribal area in Pakistan.

AIM: To estimate the rates of cataract blindness and cataract surgical coverage and to assess the visual outcome of cataract surgery among individuals aged > or =50 years in Orakzai Agency, Pakistan. METHODS: 1600 individuals aged > or =50 years were selected using probability proportional to size sampling. The main outcome measure was bilateral cataract blindness which was defined as visual acuity of <3/60 in the better eye with best available correction and with obvious central lens opacities/absence of red reflex in both eyes. RESULTS: A total of 1549 people were examined; the coverage rate was 96.8%. Of individuals who were examined, 958 (61.8%) were men. The overall prevalence of bilateral cataract blindness was 4.8% (95% CI: 3.8% to 5.9%). Women had a 2.1-fold greater prevalence of bilateral cataract blindness than men (7.1% (5.0% to 9.2%) v 3.4% (2.3% to 4.6%); p = <0.0001). However, cataract surgical coverage rates were lower for women than men. The overall quality of previous cataract surgery was poor: 43.1% eyes with cataract surgery had VA <6/60. 73.3% people with bilateral cataract blindness reported they could not undergo cataract surgery because they were too poor to afford its cost. CONCLUSION: The unacceptably high rates of cataract blindness and poor affordability and visual outcome of cataract surgery calls for the establishment, in the agency, of static cataract surgical services that are high quality, affordable, and gender sensitive.

Mine blast injuries: ocular and social aspects.

BACKGROUND/AIMS: Landmines have long been used in conventional warfare. These are antipersonnel mines which continue to injure people long after a ceasefire without differentiating between friend or foe, soldier or civilian, women or children. This study focuses on Afghan non-combatants engaged in mine clearing operations in Afghanistan in the aftermath of the Russo-Afghan war. The patterns and types of injuries seen are described and experiences in their management, ways, and means to prevent them, and recommendations for the rehabilitation of the affected individuals are given. METHODS: It is a retrospective and analytical study of 84 patients aged 19-56 years who sustained mine blast injuries during mine clearing operations in Afghanistan from November 1992 to January 1996. The study was carried out at a military hospital with tertiary care facilities. The patients were divided into three groups on the basis of their injuries. Group 1 required only general surgical attention, group 2 sustained only ocular injuries, while group 3 had combined ocular and general injuries. Patients in groups 2 and 3 were treated in two phases. The first phase aimed at immediate restoration of the anatomy, while restoration of function wherever possible was done in subsequent surgical procedures in the second phase. RESULTS: It was observed that 51 out of 84 patients (60.7%) had sustained ocular trauma of a variable degree as a result of the blasts. The mean age of the victims was 29 years and they were all male. A total of 91 eyes of 51 patients (89.2%) had been damaged. Bilaterality of damage was seen in 40 (78.4%) patients. Most, 34 (37.3%), eyes became totally blind (NPL). Only a few escaped with injury mild enough not to impair vision. Foreign bodies, small and multiple, were found in the majority of eyes; most, however, were found in the anterior segment, and posterior segment injuries were proportionally less. CONCLUSIONS: The prevalence of blindness caused by mine blast injuries is quite high. The resulting psychosocial trauma to the patients and their families is tremendous and has not been adequately highlighted. These injuries are a great drain on the country's resources. Enforcement of preventive measures and the use of protective gear and sophisticated equipment by the mine clearing personnel would prove to be far more economical in terms of human life as well as medical and economic resources. There is also need for greater attention towards the establishment of support groups and rehabilitation programmes for these individuals.

Trichophytobezoar without gastrointestinal complaints.

Gastrointestinal complaints may be the presenting symptoms of trichophytobezoar. We report a patient, who had an epigastric lump and enlarged lymph nodes on the left side of the neck, but without any gastrointestinal complaint. The clinical diagnosis suggested lymphoma or gastric cancer with secondary masses in the cervical lymph nodes. The diagnosis ultimately proved to be tubercular lymphadenitis on biopsy and gastric trichophytobezoar on endoscopy and laparotomy.

Endoscopic evaluation of peptic ulcer disease during ramadan fasting.

The effects of fasting on peptic ulcer disease were evaluated in a prospective study, involving 23 fasting patients who underwent endoscopy before and after Ramadan. Eighteen patients took an H(2)-blocker (ranitidine, 150 mg twice daily) regularly at "Suhur" and "Iftar" as prescribed, while 5 were drug defaulters. On the first endoscopy the diagnosis in 4 patients was active acute duodenal ulcer (AADU), in 8 patients was active chronic duodenal ulcer (ACDU) in 8 patients was healed duodenal ulcer (HDU), in 2 patients was erosive duodenitis (ED), and in 1 patient was chronic gastric ulcer (CGU). All of the patients with AADU showed signs of healing on repeat endoscopy. None of the ACDU patients showed signs of healing on repeat endoscopy. Instead, 7 patients in this group bled during fasting. All of the 5 drug defaulters belonged to the ACDU group. One patient in the HDU group had developed an active ulcer near the previous scar, as which was seen on repeat endoscopy. The 2 patients with ED showed signs of healing, while the only patient with CGU had bled from the same ulcer as seen on repeat endoscopy. The results were compared with those of 15 nonfasting control subjects (6 patients with ACDU, 3 with HDU, and 6 with ED as diagnosed on the first endoscopy), who took an H(2)-blocker regularly. The repeat endoscopy did not show any change in these patients. In conclusion, we inferred that Ramadan fasting may prove hazardous in patients with peptic ulcer disease in general and with active chronic ulcers in particular, although the fact that only 23 patients volunteered for this study, of whom 5 were drug defaulters, is a limitation.