Source to Tap Risk Assessment for Intermittent Water Supply Systems in Arid Regions: An Integrated FTA-Fuzzy FMEA Methodology.

Water utilities in arid regions deal with multifaceted issues of natural groundwater contamination, high treatment costs, and low water rates. These utilities rely on intermittent supplies resulting in numerous water quality failures at source, treatment, distribution, and in-house plumbing systems. The present research presents an inclusive risk assessment methodology for managing water quality from source to tap. Three-year monitoring data for turbidity, TDS, pH, iron, ammonia, nitrates, residual chlorine, Coliform group, E. coli, and Fecal Streptococci identified the root causes of failures. The cause-effect relationships in the form of a fault tree were solved using multiple failure modes and effect analysis (FMEA) to handle both the Boolean operations. The fuzzy sets addressed the uncertainties associated with data limitations in calculating exceedance probabilities (Pe) and vagueness in expert opinion for subjective evaluation of severity and detectability. The methodology was applied on a smaller system serving 18,000 consumers in Qassim, Saudi Arabia. Potable supplied water underwent reoccurrence of TDS (Pe = 20%), turbidity (Pe = 10%), and Fe (Pe = 2%) failures in distribution that further increased up to 44%, 33%, and 11% at the consumer end. The Pe for residual chlorine failure soared up to 89%. Economic controls reduced the cumulative risk to 50%, while the shift to continuous supply can limit the remaining failures under the acceptable risk. The framework will help utilities manage water quality in intermittent systems from source to tap in Saudi Arabia, the Gulf, and elsewhere.

Skin Biopsy and Histopathological Diagnosis of Dermatological Diseases.

Microscopic examination of skin and mucous membrane is an established investigation in diagnosis and follow up of many dermatological conditions frequently encountered during practice. Histopathological examination is performed with biopsied specimen from skin and or mucous membrane where required. However neither do all skin biopsies produce neither a conclusive diagnosis nor the dermatologists routinely perform this procedure to every patient they consult. This cross sectional descriptive study conducted by reviewing the records of all biopsied cases studied for histopathology in Mymensingh Medical College, Mymensingh and Shaheed Mansur Ali Medical College, Dhaka, Bangladesh from January 2012 to December 2016. The aim of this study was to investigate the favourable clinical diagnoses set by dermatologists when performing skin biopsy, the diagnoses reached by the dermatopathologists after microscopic examination, and the relationship between them and finally to comment on the instances that skin biopsy fails to fulfill the diagnostic task. Fourteen hundred and thirty six (1436) cases of skin biopsy were reviewed and descriptive statistics were performed. Maximum cases 39.1% (562) were in 2nd decade with almost equal sex distribution. The most frequently proposed clinical diagnoses included papulosquamous dermatoses 28.6% (410), whereas histological confirmation was in 13.1% (188). Histological diagnosis was more as nonspecific dermatitis 31.6% (454). After microscopic examination, a specific histological diagnosis was found in 83.5% (1199) of the cases and a consensus between clinical and histological diagnoses was observed in 69.2% (994). Neither histological diagnosis nor any feature consistent with clinical suspicion was observed in 10.1% (145) cases. Histopathological examination of skin biopsy is still a valuable diagnostic tool in many skin diseases and dermatoses with diagnostic dilemma. There are cases in which diagnostic inefficiency are being faced even after skin biopsy examination.

Estimation of Thyroid Hormone in Early Pregnancy and it's Clinical Correlation.

This descriptive cross sectional study was done for the estimation of thyroid hormone in early pregnancy and it's clinical correlation. It was conducted at the Antenatal Clinic of Mymensingh Medical College Hospital, Mymensingh from December 2010 to November 2011. Total 185 cases in early pregnancy were taken purposively and randomly. Among the pregnant women, age ranged from 18-42 years with the Mean±SD age 25.77±4.96 years, the gestational weeks ranged 6±1 to 13±1weeks having Mean±SD 9.06± 2.49 weeks. The gravida ranged from primi to 8th gravida Mean±SD 1.89±1.10. Haemoglobin level ranged from 9.0 to 13.2gm/dl; Mean±SD 10.90±0.99gm/dl. Mean±SD of serum FT4 was 17.77±7.25 and Mean±SD of TSH was 3.95±2.94mIU/L. In present study, 5.40% (n=10) of the respondents had hypothyroidism and 0.54% (n=1) showed hyperthyroidism. The present study showed that, the incidence of hypothyroidism had relatively increased then the reference ranges but not statistically significant. But hyperthyroidism was within the reference range. This study showed slightly higher percentage of hypothyroidism in both ≤30 (4.52%) and ≥30 (10%) years of age groups especially a bit higher percentage in the elderly group. In present study, hypothyroidism was common among women of lower income group. Present study showed a higher percentage of stillbirth &miscarriage among study population. This study showed a relatively higher prevalence of abnormal thyroid function (especially hypothyroidism) in the study population and suggests the routine screening of thyroid hormone in early pregnancy in addition to routine antenatal care.

Histomorphometric study of lumen of human vermiform appendix.

This study was done to find out the histomorphometry of lumen of vermiform appendix in Bangladeshi people. Total 100 fresh appendixes were collected for morphometric study of different age and sex during postmortem examination in the autopsy laboratory of Forensic Medicine Department of Mymensingh Medical College. This cross sectional descriptive study was done by convenient sampling technique. For convenience of differentiating the luminal diameter of vermiform appendix in relation to age and sex, findings were classified in four groups. Group A was up to 20 years, Group B 21-35 years, Group C 36-55 years and Group D 56-70 years. In the study the maximum diameter was in group A of female (87.00 µm) and minimum was (4.70 µm) in group B of female. The mean luminal diameter of vermiform appendix was more in female (60.71 µm) than in male (60.11 µm).

Epidemiological determinants of psoriasis.

A cross-sectional study was conducted on 102 cases having clinical manifestation of psoriasis with a view to evaluate the epidemiological determinants of psoriasis. Psoriasis constituted 1.49% of the total dermatological disorder. Seventy patients (68.6%) were males and thirty two (31.4%) were females with a male to female ratio of 2.18:1. The mean age was 30.76±13.17 years in male and 26.94±14.94 years in female. Sixteen (15.7%) patients had one or more family member having psoriasis with male and female in equal frequency. Regarding precipitating factors, psoriasis was developed after trauma in 4.9%, infection 3.9%, stressful life events 6.9% and drugs 2.9%; and was exacerbated after trauma in 5.9%, infection 5.9%, stressful life events 35.3% and drugs 12.7%. The disease showed improvement in summer (27.5%) and found deteriorated in winter (47.1%). Sunlight had beneficial effect in 33.3% of cases. During pregnancy improvement was observed in 50% but flare up in 22.2% of cases. Fifty percent of patients were smokers, 41.2% were non-smokers and 13.7% were ex-smokers. Forty percent had Body Mass Index (BMI) between 22 to 26 Kg/m², 40.2% had less than 22 Kg/m² and 15.7% had above 26 Kg/m². It was concluded that the prevalence of psoriasis among dermatological patients was similar to results reported in Turkey and in Northern India. The precipitating factors, such as smoking, stressful life events, infection, trauma, sunlight, pregnancy, drugs, and seasonal variations could influence the development of psoriasis and affect its clinical expression.

Outcome of pregnancy in women 35 years of age and above.

Pregnancy outcome among women in the age group of 35 years and more are considered to be less favorable than those of younger women. To observe those, this case control study was conducted in the department of Obstetrics & Gynaecology, Mymensingh Medical College Hospital during the period of 1st June 2003 to 31st May 2004. The study includes 100 patients of 35 years of age or above and 100 controls of 20-30 years of age. Observed complications during the pregnancy and delivery were increased incidence of placenta previa, malpresentation, intrauterine death, preterm labour, obstructed labour ruptured uterus etc. Pregnancy related complications were found significantly high (p<0.001) in case group (80%) compared to control group (51%). Rate of caesarian section was also more among the cases. Post delivery maternal complications were more in case group (53%) compared to control (30%) (p<0.001). Perinatal morbidity and mortality was significantly high. Cause of late fetal death in older women include, failure of the uterine vasculature in older women to adapt sufficiently to the increase haemodynamic demands of pregnancy, reduced fetal oxygenation with maternal age and also a rise in the frequency of preexisting hypertension with age. Maternal age is an important and independent risk in pregnancy outcome.

Association between morphological changes of nail and nail arsenic level in patients with arsenicosis.

This case-control type of analytical study was conducted in the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh to find out the association between morphological changes of nail and nail arsenic level in arsenicosis patients. Majority of arsenicosis patients were male (56.67%). The mean age of the cases was 43.07+/-13.73 years. Nail changes were found in 26.67% of cases, most were nail dystrophy (23.33%) and rest were Mee's line (3.34%). There was significant difference between cases with or without nail changes and nail arsenic level. But cases with or with out nail changes had a significant difference between duration of intake of arsenic contaminated water. There was no correlation between nail changes and nail arsenic level for nail dystrophy and Mee's line. The study result failed to establish association between the morphological changes of nail and nail arsenic level.

A study to evaluate the efficacy and safety of oral fluconazole in the treatment of tinea versicolor.

In our study of 6 month of pityriasis versicolor patient in skin department of Mymensingh Medical College Hospital outdoor, most of the patient was of age 16-25 years (63.33%), 20% was of age 26-35 years and 16.67% was of 36-45 years. Age distribution among male patient maximum (66.67%) was of 16-25 years and among females the maximum 50% was also of 16-25 years. Mostly was male (80%) and 20% was female only 20% of the patient has got the positive family history whereas 80% with no family history of the disease, which indicates that there is no hereditary predilection. Of the patient 66.67% was unmarried and 33.33% was married. Late adolescence & early adult age groups are predominantly affected. Small children & elderly adults are infected only in unusual circumstances, such as prolonged occlusion or immunosuppresion. Prevalence reported to be as high as 50% in the humid, hot environment of Western Samoa & on low as 11.1% in the colder temperature of Sweden. About sex distribution of patients 20% were female. The study shows that majority of patients were male (20%).

Histomorphological study of lymphoid follicle of vermiform appendix.

The study was done to find out the number of lymphoid follicle of vermiform appendix in Bangladeshi people and to increase the knowledge regarding variational anatomy in our population. Total 40 fresh appendixes were collected for histological study of different age and sex during postmortem examination in the autopsy laboratory of Forensic department of Mymensingh Medical College. This cross sectional descriptive study was done by convenient sampling technique. For convenience of differentiating the number of lymphoid follicle of vermiform appendix in relation to age and sex, findings were classified in four groups, up to 20 years, 21 to 35 years, 36 to 55 years and 56 to 70 years. In the present study the number of lymphoid follicle were highest in group A, mean were (5.40+/-1.30) and lowest in group D where mean were (1.05+/-0.35). In male mean were 3.16 and in female mean were 2.86. Diameter of the lymphoid follicle in group A was highest (40.14+/-2.66) and lowest in group D (0.24+/-1.35). Number of germinal centre are highest in group B (2.20 +/- 0.45) and lowest in group D (0.00 +/- 0.00).