SALUS-A Study on Self-Tonometry for Glaucoma Patients: Design and Implementation of the Electronic Case File.

BACKGROUND: In times of omnipresent digitization and big data, telemedicine and electronic case files (ECFs) are gaining ground for networking between players in the health care sector. In the context of the SALUS study, this approach is applied in practice in the form of electronic platforms to display and process disease-relevant data of glaucoma patients. OBJECTIVES: The SALUS ECF is designed and implemented to support data acquisition and presentation, monitoring, and outcome control for patients suffering from glaucoma in a clinical setting. Its main aim is to provide a means for out- and inpatient exchange of information between various stakeholders with an intuitive user interface in ophthalmologic care. Instrument data, anamnestic data, and diagnostic assessments need to be accessible and historic data stored for patient monitoring. Quality control of the data is ensured by a reading center. METHODS: Based on an intensive requirement analysis, we implemented the ECF as a web-based application in React with a Datomic back-end exposing REST and GraphQL APIs for data access and import. A flexible role management was developed, which addresses the various tasks of multiple stakeholders in the SALUS study. Data security is ensured by a comprehensive encryption concept. We evaluated the usability and efficiency of the ECF by measuring the durations medical doctors need to enter and work with the data. RESULTS: The evaluation showed that the ECF is time-saving in comparison to paper-based assessments and offers supportive monitoring and outcome control for numerical and imaging-related data. By allowing patients and physicians to access the digital ECF, data connectivity as well as patient autonomy were enhanced. CONCLUSION: ECFs have a great potential to efficiently support all patients and stakeholders involved in the care of glaucoma patients. They benefit from the efficient management and view of the data tailored to their specific role.

Addressing differences in cancer: a framework for synergistic programming in cancer prevention and control.

Background: Cancer remains a leading cause of death worldwide and continues to disproportionately impact certain populations. Several frameworks have been developed that illustrate the multiple determinants of cancer. Expanding upon the work of others, we present an applied framework for cancer prevention and control designed to help clinicians, as well as public health practitioners and researchers, better address differences in cancer outcomes. Methods: The framework was developed by the Cancer Prevention and Control Research Network's Health Behaviors Workgroup. An initial framework draft was developed based on workgroup discussion, public health theory, and rapid literature review on the determinants of cancer. The framework was refined through interviews and focus groups with Federally Qualified Health Center providers (n=2) and cancer patients (n=2); participants were asked to provide feedback on the framework's causal pathways, completeness, and applicability to their work and personal life. Results: The framework provides an overview of the relationships between sociodemographic inequalities, social and structural determinants, and key risk factors associated with cancer diagnosis, survivorship, and cancer morbidity and mortality across the lifespan. The framework emphasizes how health-risk behaviors like cigarette smoking interact with psychological, psychosocial, biological, and psychosocial risk factors, as well as healthcare-related behavior and other chronic diseases. Importantly, the framework emphasizes addressing social and structural determinants that influence health behaviors to reduce the burden of cancer and improve health equity. Aligned with previous theory, our framework underscores the importance of addressing co-occurring risk factors and disease states, understanding the complex relationships between factors that influence cancer, and assessing how multiple forms of inequality or disadvantage intersect to increase cancer risk across the lifespan. Conclusions: This paper presents an applied framework for cancer prevention and control to address cancer differences. Because the framework highlights determinants and factors that influence cancer risk at multiple levels, it can be used to inform the development, implementation, and evaluation of interventions to address cancer morbidity and mortality.

Demographic and Clinical Characteristics of Functional Dyspepsia and Its Subtypes in Adult Patients: An Experience from a Tertiary Care Centre in Bangladesh.

Functional dyspepsia (FD) is a common gastrointestinal problem in the world. The Rome III consensus subdivided functional dyspepsia into two groups: meal-related postprandial distress syndrome (PDS) and meal-unrelated epigastric pain syndrome (EPS). Limited data are available regarding FD in Bangladesh. The aim of this study was to investigate the demographic and clinical characteristics of FD and its sub-types. This cross-sectional study was conducted in which we recruited patients who attended the outpatient department of Gastroenterology of Bangabandhu Sheikh Mujib Medical University, Bangladesh from March 2017 to February 2018. Patients fulfilling Rome III FD criteria and a negative upper GIT endoscopy were included for this study. The patients were then subdivided into 'pure' PDS (i.e. meeting criteria for PDS without EPS symptoms), 'pure' EPS (i.e., meeting criteria for EPS without PDS symptoms), and overlapping PDS-EPS (i.e., symptoms of both PDS and EPS) groups. Total of 368 FD patients (56.0% females, mean age 32.8±8.6 years, BMI: 22.0±2.7), were included in this study. Out of them, 112(30.4%) patients (57.2% females, mean age 33.9±9.3 years, BMI: 22.0±2.7) fulfilled criteria of pure EPS and 64(17.4%) patients (68.8% females, mean age 33.2±7.8 years, BMI: 22.1±2.4) fulfilled criteria of pure PDS. However, the majority of patients [192(52.2%), 52.1% females, mean age 32.0±8.4 years, BMI: 21.9±2.8] had symptoms of overlapping EPS-PDS. More than 40% of patients in our study presented with 3 or more of the four key symptoms of FD. A longer duration of presenting symptoms was seen among patients with overlapping EPS-PDS in comparison to pure EPS and pure PDS (p<0.001). A significant overlap of symptoms of both EPS and PDS was noticed among patients with FD. The value of dividing functional dyspepsia into the subgroups of PDS and EPS is thus questionable. Further research and modification of the diagnostic criteria for FD subtypes are necessary.

Association of Chest Pain with Rate Pressure Product and ST-segment Changes after Sub Arachnoid Block in Caesarean Section.

When healthy women undergo caesarean section (CS) under sub arachnoid anaesthesia, transient electrocardiographic changes, such as ST-segment depression and T-wave abnormalities, are observed. During an elective caesarean section under sub arachnoid anaesthesia, about one-third of healthy parturient experience chest pain and ECG changes suggestive of myocardial ischemia. To assess the ST-segment and Rate Pressure Product changes with chest pain in patients with elective caesarean section under subarachnoid block. The Department of Anesthesia, Analgesia and Intensive Care Medicine at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh was the site of this prospective observational study. The study included 86 healthy women between the ages of 20 and 35 who needed an elective caesarean section under a single shot sub arachnoid block and who visited the Department of Anesthesia, Analgesia, and Intensive Care Medicine at BSMMU in Shahbagh, Dhaka from January 2019 to June 2019. In comparison to the no chest pain group, ST-segment changes among the chest pain group at delivery, 5 minute, 10 minute after delivery and at the end of the surgery were highly significant (p=0.001). Comparatively, Rate Pressure Product changes were found to be significantly higher in the group with chest pain than in the group without chest pain (p=0.001). It is concluded that there is a substantial association of chest pain with rate pressure product and ST-segment changes after subarachroid block in caesarean section.

Dexmedetomidine as an Adjuvant to Bupivacaine in Caudal Analgesia in Children Undergoing Infra-Umbilical Surgery.

When performing infra-umbilical procedures, caudal epidural analgesia with bupivacaine is frequently used to provide both intra- and post-operative analgesia. Dexmedetomidine, an alpha 2 agonistsare extensively used in neuraxial blocks and peripheral nerve blocks to prolong the action of bupivacaine. To find out the effects of dexmedetomidine as an adjuvant to bupivacaine for caudal analgesia in children undergoing infra-umbilical surgery. This was a randomized, controlled double-blinded prospective observational study and was performed from July 2019 to December 2019. A total of 60 (Sixty) patients with different infra-umbilical surgical problems underwent different procedure under caudal anaesthesia in different operation theatre in Bangabandhu Sheikh Mujib Medical University, Dhaka were enrolled in this study. Elaborate personal history, meticulous clinical examinations and relevant laboratory investigations was done. Post-operative adverse effects also were monitored. All information from history of illness, clinical, laboratory findings, duration of analgesia and post-operative adverse effects were recorded in a preformed data sheet (Appendix-I) and statistical analysis was done by SPSS 22.0. Mean age of the children in Group A (dexmedetomidine + bupivacaine) was 5.50±2.61 years and in Group B (bupivacaine) was 5.66±2.75. Mean weight of the children in Group A was 19.22±8.58 kg and in Group B was 19.70±8.94 kg in this study. Mean duration of anaesthesia was 27.5±6.5 minute in Group A and 28.5±5.5 minute in Group B. The mean duration of analgesia was 4.32±0.54 hours for Group A and 2.12±0.32 hours in Group B. In Group A, 46.7% patients required 1 and 3.3% required 2 rescue analgesic but in Group B, 43.3% patients required single rescue analgesic and 33.3% required two rescue analgesics (p<0.05). In Group A, 6.7% patients had nausea/ vomiting and in Group B, 16.7% patients had nausea/ vomiting (p>0.05). It can be concluded that dexmedetomidine with bupivacaine for caudal analgesia in infra-umbilical surgery significantly prolongs the duration of postoperative analgesia when compared to bupivacaine alone without any side-effects.

Modeling the effect of acquired resistance on cancer therapy outcomes.

Adaptive therapy (AT) is an evolution-based treatment strategy that exploits cell-cell competition. Acquired resistance can change the competitive nature of cancer cells in a tumor, impacting AT outcomes. We aimed to determine if adaptive therapy can still be effective with cell's acquiring resistance. We developed an agent-based model for spatial tumor growth considering three different types of acquired resistance: random genetic mutations during cell division, drug-induced reversible (plastic) phenotypic changes, and drug-induced irreversible phenotypic changes. These three resistance mechanisms lead to different spatial distributions of resistant cells. To quantify the spatial distribution, we propose an extension of Ripley's K-function, Sampled Ripley's K-function (SRKF), which calculates the non-randomness of the resistance distribution over the tumor domain. Our model predicts that the emergent spatial distribution of resistance can determine the time to progression under both adaptive and continuous therapy (CT). Notably, a high rate of random genetic mutations leads to quicker progression under AT than CT due to the emergence of many small clumps of resistant cells. Drug-induced phenotypic changes accelerate tumor progression irrespective of the treatment strategy. Low-rate switching to a sensitive state reduces the benefits of AT compared to CT. Furthermore, we also demonstrated that drug-induced resistance necessitates aggressive treatment under CT, regardless of the presence of cancer-associated fibroblasts. However, there is an optimal dose that can most effectively delay tumor relapse under AT by suppressing resistance. In conclusion, this study demonstrates that diverse resistance mechanisms can shape the distribution of resistance and thus determine the efficacy of adaptive therapy.

Effective dose window for containing tumor burden under tolerable level.

A maximum-tolerated dose (MTD) reduces the drug-sensitive cell population, though it may result in the competitive release of drug resistance. Alternative treatment strategies such as adaptive therapy (AT) or dose modulation aim to impose competitive stress on drug-resistant cell populations by maintaining a sufficient number of drug-sensitive cells. However, given the heterogeneous treatment response and tolerable tumor burden level of individual patients, determining an effective dose that can fine-tune competitive stress remains challenging. This study presents a mathematical model-driven approach that determines the plausible existence of an effective dose window (EDW) as a range of doses that conserve sufficient sensitive cells while maintaining the tumor volume below a threshold tolerable tumor volume (TTV). We use a mathematical model that explains intratumor cell competition. Analyzing the model, we derive an EDW determined by TTV and the competitive strength. By applying a fixed endpoint optimal control model, we determine the minimal dose to contain cancer at a TTV. As a proof of concept, we study the existence of EDW for a small cohort of melanoma patients by fitting the model to longitudinal tumor response data. We performed identifiability analysis, and for the patients with uniquely identifiable parameters, we deduced patient-specific EDW and minimal dose. The tumor volume for a patient could be theoretically contained at the TTV either using continuous dose or AT strategy with doses belonging to EDW. Further, we conclude that the lower bound of the EDW approximates the minimum effective dose (MED) for containing tumor volume at the TTV.

Predicting Difficult Intubation by using Modified Mallampati (MMT) with or without Thyromental Height Test (TMHT).

Failed Tracheal Intubation with Subsequent inability to maintain an open airway and adequate oxygenation is the most frequent cause of brain damage or death during anesthesia. Recognizing before anesthesia the potential for difficult intubation allows time for optimal preparation. Proper Selection of equipment and techniques is needed to avoid unwanted situation. To find out difficulties associated with endotracheal intubation using Modified Mallampati Test (MMT) combined with Thyromental Height Test (TMHT) and MMT without TMHT. This prospective observational study was conducted at the Department of Anesthesia in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from April 2018 to September 2018. Two hundred two patients with different surgical procedures under general anaesthesia in different operation theaters of BSMMU, Dhaka were selected as study population. After taking written consents from each patient or his/her attendant elaborate history of illness, meticulous clinical examinations were performed and relevant laboratory investigations were done. All information was recorded in a preformed data sheet and statistical analysis was done by SPSS-22.0. Mean age ±SD of the study subjects was 42.49±14.29 years in MMT with TMHT group and 43.40±15.39 years in MMT without TMHT group. Females were enrolled more than males in both the groups. BMI was 28.75±3.59kg/m² in MMT with TMHT group and 29.44±8.64kg/m² in MMT without TMHT group. There were no significant differences in age, gender and BMI between the groups. Sensitivity, specificity, PPV, NPV and accuracy were 100.0%, 96.0%, 96.2%, 100.0% and 98.0% respectively of MMT with TMHT in predicting intubation difficulty. Sensitivity, specificity, PPV, NPV and accuracy were 100.0%, 96.0%, 96.2%, 100.0% and 98.0% respectively of MMT only in predicting intubation difficulty. MMT combined with TMHT is a better predictor of intubation difficulty than MMT alone.

Understanding the Role of Environmental Transmission on COVID-19 Herd Immunity and Invasion Potential.

COVID-19 is caused by the SARS-CoV-2 virus, which is mainly transmitted directly between humans. However, it is observed that this disease can also be transmitted through an indirect route via environmental fomites. The development of appropriate and effective vaccines has allowed us to target and anticipate herd immunity. Understanding of the transmission dynamics and the persistence of the virus on environmental fomites and their resistive role on indirect transmission of the virus is an important scientific and public health challenge because it is essential to consider all possible transmission routes and route specific transmission strength to accurately quantify the herd immunity threshold. In this paper, we present a mathematical model that considers both direct and indirect transmission modes. Our analysis focuses on establishing the disease invasion threshold, investigating its sensitivity to both transmission routes and isolate route-specific transmission rate. Using the tau-leap algorithm, we perform a stochastic model simulation to address the invasion potential of both transmission routes. Our analysis shows that direct transmission has a higher invasion potential than that of the indirect transmission. As a proof of this concept, we fitted our model with early epidemic data from several countries to uniquely estimate the reproduction numbers associated with direct and indirect transmission upon confirming the identifiability of the parameters. As the indirect transmission possess lower invasion potential than direct transmission, proper estimation and necessary steps toward mitigating it would help reduce vaccination requirement.

Comparative study of a mathematical epidemic model, statistical modeling, and deep learning for COVID-19 forecasting and management.

The COVID-19 pandemic has caused a global crisis with 47,209,305 confirmed cases and 1,209,505 confirmed deaths worldwide as of November 2, 2020. Forecasting confirmed cases and understanding the virus dynamics is necessary to provide valuable insights into the growth of the outbreak and facilitate policy-making regarding virus containment and utilization of medical resources. In this study, we applied a mathematical epidemic model (MEM), statistical model, and recurrent neural network (RNN) variants to forecast the cumulative confirmed cases. We proposed a reproducible framework for RNN variants that addressed the stochastic nature of RNN variants leveraging z-score outlier detection. We incorporated heterogeneity in susceptibility into the MEM considering lockdowns and the dynamic dependency of the transmission and identification rates which were estimated using Poisson likelihood fitting. While the experimental results demonstrated the superiority of RNN variants in forecasting accuracy, the MEM presented comprehensive insights into the virus spread and potential control strategies.

Sustainable food drying technologies based on renewable energy sources.

Waste in the food supply chain is estimated to be about 30-40% of the total food production, which aggravates the world hunger and increases waste management burden and environmental impact. Despite the dire food scarcity, majority of this food waste takes place in developing countries because of the lack of appropriate and affordable preservation techniques. Traditional open sun drying is the most popular food-reservation technique to the local farmers due to near-zero capital cost and cheap labor cost. However, this method is highly energy intensive, unhygienic, and time demanding. The high energy consumption resulting from uncontrolled simultaneous heat, mass, and momentum transfer processes in traditional drying systems highlights the necessity of pursuing sustainability in drying process targeting reduced energy consumption, environmental and social impacts. This paper presents a comprehensive review on the sustainable food drying technologies based on renewable energy sources, with emphasis on the developing countries. It was observed that the integration of thermal energy storage with heat pump makes the integrated drying system more efficient, and dries food with better quality. Likewise, advanced integrated drying systems, such as, solar with microwave, and heat pump with microwave make the drying process more cost and quality competent. Finally, impact of resource distribution and governmental incentives for renewable energy use in sustainable drying is discussed.

Liming effects of poultry litter derived biochar on soil acidity amelioration and maize growth.

Crop production in acid soils is facing enormous challenges due to low soil quality associated with an increase in the acidification rate and aluminum toxicity. Despite comprehensive prior work with biochar application on nutrient availability and crop productivity in acid soils, little information is available about the recommendation or standardization of biochar application rates that are more suitable for soil fertility improvement under different soil environments (physico-chemical properties) for maximizing the benefits of biochar applications and minimizing the potential environmental risk. Thus, the objective of this study was to investigate the effectiveness of poultry litter (PL) and poultry litter biochar (PLB) in ameliorating the fertility of acid soils through incubation and pot experiments. The soil was amended with different materials as follows; lime (1 g kg-1), PL (5, 10 and 15 g kg-1) and PLB (5, 10 and 15 g kg-1) along with control (non-amended). A pot experiment was also conducted using similar treatments to observe the responses of maize crop to the different amendments. The results indicated an increase in the pH and a decrease in exchangeable acidity in lime, PL and PLB amended soils. Lower soil pH, base cations and soil available phosphorus (P), and higher exchangeable acidity were found in control than the amended soils. Compared to PL and lime, PLB achieved greater increase rate in soil pH and reduction rate in soil exchangeable acidity with increased soil exchangeable base cations. An increase in soil available calcium (Ca) was observed in the lime treatment, while in PL and PLB treatments, there was an increase in soil available Ca, magnesium (Mg), potassium (K) and P. Application of the amendments increased availability of nitrogen (N), P, K, Ca and Mg relative to the control for maize in the pot experiment. When PL and PLB amendments were compared, it was found that the PLB was the best choice for the amelioration of acid soils as well as nutrient uptake by maize plants. It is suggested that application of PLB at the rate of 15 g kg-1 is suitable for maize growth in acid soils.

Global implications of regional grain production through virtual water trade.

Crop yields (Y) and virtual water content (VWC) of agricultural production are affected by climate variability and change, and are highly dependent on geographical location, crop type, specific planting and harvesting practice, soil property and moisture, hydro-geologic and climate conditions. This paper assesses and analyzes historical (1985-2009) and future (2040-2064) Y and VWC of three cereal crops (i.e., wheat, barley, and canola) with high spatial resolution in the highly intensive agricultural region of Alberta, Canada, using the Soil and Water Assessment Tool (SWAT). A calibrated and validated SWAT hydrological model is used to supplement agricultural (rainfed and irrigation) models to simulate Y and crop evapotranspiration (ET) at the sub-basin scales. The downscaled climate projections from nine General Climate Models (GCMs) for RCP 2.6 and RCP 8.5 emission scenarios are fed into the calibrated SWAT model. Results from an ensemble average of GCMs show that Y and VWC are projected to change drastically under both RCPs. The trade (export-import) of wheat grain from Alberta to more than a hundred countries around the globe led to the annual saving of ~5 billion m3 of virtual water (VW) during 1996-2005. Based on the weighted average of VWC for both rainfed and irrigated conditions, future population and consumption, our projections reveal an annual average export potential of ~138 billion m3 of VW through the flow of these cereal crops in the form of both grain and other processed foods. This amount is expected to outweigh the total historical provincial water yield of 66 billion m3 and counts for 47% of total historical precipitation and 61% of total historical actual ET. The research outcome highlights the importance of local high-resolution inputs in regional modeling and understanding the local to global water-food trade policy for sustainable agriculture.

Role of Oral Clonidine Premedication on Intra-operative Haemodynamics and PONV in Laparoscopic Cholecystectomy.

Laparoscopic cholecystectomy is a gold standard surgical procedure for gallbladder operation. It causes altered haemodynamic responses due to pneumoperitoneum and surgical procedure also causes high incidence of postoperative nausea &vomiting. Clonidine has been shown to reduce intraoperative haemodynamic instability. This randomized prospective single blind clinical study was designed to evaluate the efficacy of oral clonidine premedication for attenuation of haemodynamic responses associated with pneumoperitoneum & also reduce the incidence of postoperative nausea & vomiting and carried out in the department of Anaesthesia Analgesia and Intensive care Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2010 to June 2010. Sixty adult patients of ASA physical status I & II scheduled for elective laparoscopic cholecystecomy were recruited for a prospective randomized single blind study. They were selected randomized into two equal groups, thirty in each group. Group A received no premedication & Group B (Clonidine) received clonidine (100µgm) orally 60 minutes before induction of anaesthesia. Pulse rate, mean arterial pressure were recorded prior to induction, 2 minutes after endotracheal intubation, before pneumoperitoneum, 10 minutes & 20 minutes after pneumoperitoneum, 10 minutes after release of carbon dioxide & 10 minutes after extubation. Patients in Group B (Clonidine) maintained greater haemodynamic stability intraoperatively compare to Group A after intubation, during pneumoperitoneum and also extubation. Pulse rate & mean arterial pressure significantly varies in Group A compare with Group B (Clonidine) at different times of intraoperative period (p<0.05). Postoperative nausea & vomiting was significantly less in Group B (Clonidine). Premedication with oral clonidine attenuates the haemodynamic responses produced by pneumoperitoneum during laparoscopic cholecystectomy and also significantly nausea and vomiting, results better patient satisfaction and cost effective.

Optimal control problems of mosquito-borne disease subject to changes in feeding behavior of Aedes mosquitoes.

Dengue viruses (DENV) are transmitted to humans by the bite of Aedes mosquitoes. It is known that dengue virus infection in Aedes aegypti female mosquitoes makes a change in the feeding behavior of the infected mosquitoes. In this study, using the forces of infection, we incorporated the effect of changes in the feeding behavior of mosquitoes into the standard vector-borne SIR-SI model. It has been proved that both a single-strain model and a two-strain model exhibit forward bifurcations. Moreover, optimal implementations of control with specific prevention measures for dengue transmission are analyzed. As a result we found that more implementation of controls on the secondary infection of humans should be considered for the behavioral changes in feeding of the infected mosquitoes.

Analysis of a vector-bias effect in the spread of malaria between two different incidence areas.

In 2005, Lacroix et al. demonstrated that infected humans are more attractive to mosquitoes, a phenomenon known as the vector-bias effect. The aim of this study was to determine how a vector-bias effect affects the changes in the dynamics of malaria transmission, and the changes in control strategies and cost-effectiveness for optimal control considering the regional characteristics or force of infections for different transmission rates. We used a vector-bias mathematical model and considered two different incidence areas: a high transmission area and a low transmission area. Our results showed that the dynamics in the two areas differed; as bias exists and the strategy for optimal control could be changed in the different areas. Thus, this work may give that considering the vector-bias effect in different areas facilitates prediction of the future dynamics and make decisions for establishing controls. We also mention the evolution of malaria parasites in this study.

Structural Variations of Nose and Paranasal Sinuses in Various Sinonasal Pathologies: Tomographic Study of 50 Cases in Bangladeshi People.

The aim of this study was to determine the frequency of structural variations in nose & paranasal sinuses in computed tomography in Bangladeshi people. This retrospective study was done at the Sir Salimullah Medical College Mitford Hospital and Apollo Hospitals, Dhaka, Bangladesh. Fifty (50) CT scan of Nose and Para nasal sinuses were collected from the patients presented with different sinonasal pathologies in OPD, IPD of both hospitals from July 2013 to June 2014. The scans were reviewed for the presence of different structural variations of nose and paranasal sinuses. The age range of the patients was 25 to 65 years. The most common anatomical variation in this study was hypertrophied inferior turbinate (82%) followed by ethmoidal bulla (70%), deviated nasal septum (64%), agar nasi cell (40%), concha bullosa (38%). In most of the patients we found more than one variation. There is wide range of anatomical variations in nose and paranasal sinuses which might be regarded as the aetiological factors of different sinonasal pathologies. To maximize patients' benefit and to avoid unexpected situations during surgeries as well as dreadful complications, individualized pre-planning through tomographic study should be considered.

Comparison between Angiographic Findings of Coronary Artery Disease in STEMI and NSTEMI Patients of Bangladesh.

Coronary Angiogram (CAG) has been used to detect coronary artery disease in myocardial infarction (both STEMI and NSTEMI) patients. The purpose of this study was to compare the degree of coronary artery disease among STEMI and NSTEMI patients. Among acute coronary syndrome in NSTEMI we found more widespread coronary artery disease other than STEMI. Lack of documentations encouraged us to perform this study in our center. In this retrospective observational study we summarized all myocardial infarction (MI) patients who underwent coronary angiography (CAG) from August 2013 to August 2014 at Enam Medical College Hospital, Dhaka, Bangladesh and data of degree of coronary artery disease were recorded. Data of 100 consecutive MI patients who underwent CAG during that period were recorded. Among them 50 patients having STEMI as Group I (male 45, female 5) & other 50 patients sustained NSTEMI as Group II (male 38, female 12). Among NSTEMI patient group 80% were having multi-vessel disease and in STEMI patient group 80% having single vessel disease and remaining having multi-vessel disease. The degree of coronary artery disease is extensive in NSTEMI patients than in STEMI group. Coronary angiogram can visualize the degree of coronary artery involvement and is a useful screening modality to compare disease extent in MI patients.

Gitelman's Syndrome Presenting with Hypocalcaemia - A Case Report.

Gitelman's syndrome is an autosomal recessive renal tubular disorder characterized by severe hypomagnesaemia, hypokalaemia, metabolic alkalosis and hypocalcaemia. It is caused by defective NaCl transport in the Distal Convoluted Tubule and presents in adolescence or adulthood, with a distinctly more benign course than Bartter's Syndrome. The dominant clinical features are muscle weakness, fatigue, carpopedal spasm, cramps and tetany. We report the case of a 26 year old male who presented with flaccid quadriparesis and carpopedal spasms, hypokalaemia, hypomagnesaemia, hypocalcaemia and severe urinary magnesium wasting. He was treated with potassium and magnesium supplementation and regained full function of all limbs.

Amelioration of an Ultisol profile acidity using crop straws combined with alkaline slag.

The acidity of Ultisols (pH <5) is detrimental to crop production. Technologies should be explored to promote base saturation and liming effect for amelioration of Ultisol pH. Column leaching experiments were conducted to investigate the amelioration effects of canola straw (CS) and peanut straw (PS) in single treatment and in combination whether with alkaline slag (AS) or with lime on Ultisol profile acidity. The treatment without liming materials was set as control, and the AS and lime in single treatment are set for comparison. Results indicated that all the liming materials increase soil profile pH and soil exchangeable base cations at the 0-40-cm depth, except that the lime had amelioration effect just on 0 to 15-cm profile. The amelioration effect of the liming materials on surface soil acidity was mainly dependent on the ash alkalinity in organic materials or acid neutralization capacity of inorganic materials. Specific adsorption of sulfate (SO4(2-)) or organic anions, decarboxylation of organic acids/anions, and the association of H(+) with organic anions induced a "liming effect" of crop residues and AS on subsoil acidity. Moreover, SO4(2-) and chloride (Cl(-)) in PS, CS, and AS primarily induced base cations to move downward to subsoil and exchange with exchangeable aluminum (Al(3+)) and protons (H(+)). These anions also promoted the exchangeable Al to leach out of the soil profile. The CS was more effective than PS in decreasing soil acidity in the subsoil, which mainly resulted from higher sulfur (S) and Cl content in CS compared to PS. The CS combined with AS was the better amendment choice in practical agricultural systems.