Knowledge and Attitudes Regarding Do-Not-Resuscitate Decisions Among Clinical-Year Medical Students and Interns in the Western Region of Saudi Arabia.

Background The directive to withhold emergent interventions in the case of cardiac and/or respiratory arrest with the continuation of standard care and therapy is known as do-not-resuscitate (DNR). The diversity of DNR guidelines depends on moral and religious factors. In Saudi Arabia, a DNR policy was published in 2017 which corresponds to the religious and ethical aspects of Islamic law. To augment future awareness regarding DNR decisions, as they are an essential element in critical care medicine, the foundational principles of DNR must be provided during the clinical years of medical school. Objectives The current study aims to assess and evaluate the knowledge and attitudes regarding DNR decisions among clinical-year medical students and interns in the Western Region of Saudi Arabia. Methods A cross-sectional study was carried out from October to December 2023, utilizing a self-administered online survey distributed via social media platforms. After receiving ethical approval from the institutional review board, data were collected from clinical-year medical students and interns in the Western Region of Saudi Arabia, and an appropriate statistical analysis was performed. Results A total of 397 participants were enrolled in this study. More than half (n = 251, 63.2%) were from Umm Al-Qura University, while the remaining (n=79, 19.9%) were from Taibah University. Of the total, 258 (65%) were male participants, and 139 (35%) were female. A total of 152 (38.3%) were fifth-year medical students, and 102 (25.7%) were interns. The vast majority (n = 364, 91.7%) had heard the term DNR, with the most reported source of information being from healthcare providers (n = 306, 83.2%), while a minority (n = 33, 8.3%) had not. Of the respondents, 226 (56.9%) identified the presence of a clear DNR policy in Saudi Arabia, and 77 (19.4%) had previously had experience with DNR. Most of the studied population (n = 333, 83.9%) expressed a willingness to take a lecture/session regarding DNR. Most of our participants, 347 (87.4%), believe it is essential to consider legal concerns when making a DNR decision. Interestingly, 152 (38.5%) of the participants think it is acceptable to be conservative in investigations and treatments with patients who are labeled as DNR, and 223 (56.2%) agree that patients should be aware of their DNR status. Approximately three-quarters of the study population (n = 290, 73%) agreed that it is stressful to discuss the possibility of a DNR order. In the association of who heard about DNR more, 101 (99%) of the interns had heard about the term DNR, while only 53 (75.7%) of the fourth-year medical students had. At the same time, 74 (72.5%) of the interns showed a positive attitude regarding the DNR definition, compared to 33 (47.1%) of the fourth-year medical students. Conclusion This study highlights the necessity of integrating educational interventions into DNR decisions in addition to clinical placement in the intensive care unit as part of the medical school curriculum.

An overview of the taxonomic instability of endangered Golden and Zhobi mahseer in Pakistan / Uma visão geral da instabilidade taxonômica do golden em perigo e do Zhobi mahseer no Paquistão

Abstract In South and South East Asia three genera of fish species i.e. Tor, Neolissochilus and Naziritor are commonly known as Mahseer with at least 47 species. Among these 23 belongs to genus Tor, 22 to Neolissochilus and one to Naziritor i.e. Naziritor zhobensis. Recently another species added to genus Naziritor is Naziritor chelynoides in India. Among Tor species Tor putitora (Hamilton) is the most widely distributed Mahseer in Pakistan and other countries of the Indian subcontinent. However, based alone on morphological characters some authors identify the Pakistani counterparts as Tor macrolepis (Heckel), (a species presumed to be found exclusively in the Indus River system) distinct from Tor putitora (a species found in Ganga Brahmaputra River system). In order to resolve this taxonomic ambiguity, present study carried out meristic and morphometric measurements of Mahseer collected from a total of 11 water bodies of Pakistan. Ratios between the morphometric characters were calculated and statistically analyzed using t-test and correlation coefficient. Two species identified as Tor putitora and Naziritor zhobensis were the sole Mahseer inhabitants of Indus system in Pakistan. Tor putitora occurred at all surveyed sites while Nazirtor zhobensis had a distribution range from river Zhob to tributaries of river Gomal the right bank tributaries of River Indus. The study corroborates that there are no unequivocal morphological synapomorphies in any existing populations of both species. The study further demonstrates that head length, a character frequently used in Mahseer taxonomy, is not a good measure for species identification. Finally the present study establishes that Naziritor zhobensis still exists in the water bodies of Pakistan and that golden Mahseer occurring in Indus riverine system of Pakistan is Tor putitora.

Resumo No sul e sudeste da Ásia, três gêneros de espécies de peixes, ou seja, Tor, Neolissochilus e Naziritor, são comumente conhecidos como Mahseer com pelo menos 47 espécies. Entre estas, 23 pertencem ao gênero Tor, 22 a Neolissochilus e um a Naziritor, ou seja, Naziritor zhobensis. Recentemente, outra espécie adicionada ao gênero Naziritor é Naziritor chelynoides na Índia. Entre as espécies de Tor, Tor putitora (Hamilton) é o Mahseer mais amplamente distribuído no Paquistão e em outros países do subcontinente indiano. No entanto, com base apenas em caracteres morfológicos, alguns autores identificam as contrapartes paquistanesas como Tor macrolepis (Heckel) (uma espécie que se presume ser encontrada exclusivamente no sistema do rio Indo), distinta de Tor putitora (uma espécie encontrada no sistema do rio Ganga Brahmaputra). A fim de resolver essas ambiguidades taxonômicas, o presente estudo realizou medidas merísticas e morfométricas de Mahseer coletadas em um total de 11 corpos d'água do Paquistão. As razões entre os caracteres morfométricos foram calculadas e analisadas estatisticamente usando o teste t e o coeficiente de correlação. Duas espécies identificadas como Tor putitora e Naziritor zhobensis foram os únicos habitantes Mahseer do sistema fluvial Indo no Paquistão. Tor putitora ocorreu em todos os locais pesquisados, enquanto Nazirtor zhobensis tinha uma faixa de distribuição do rio Zhob aos afluentes do rio Gomal, afluentes da margem direita do rio Indo. O estudo corrobora que não há sinapomorfias morfológicas inequívocas em nenhuma das populações existentes de ambas as espécies. O estudo demonstra ainda que o comprimento da cabeça, um caractere frequentemente usado na taxonomia de Mahseer, não é boa medida para identificação das espécies. Finalmente, o presente estudo estabelece que Naziritor zhobensis ainda existe nos corpos d'água do Paquistão e que o Mahseer dourado ocorrendo no sistema fluvial Indo do Paquistão é Tor putitora.

An overview of the taxonomic instability of endangered Golden and Zhobi mahseer in Pakistan / Uma visão geral da instabilidade taxonômica do golden em perigo e do Zhobi mahseer no Paquistão

In South and South East Asia three genera of fish species i.e. Tor, Neolissochilus and Naziritor are commonly known as Mahseer with at least 47 species. Among these 23 belongs to genus Tor, 22 to Neolissochilus and one to Naziritor i.e. Naziritor zhobensis. Recently another species added to genus Naziritor is Naziritor chelynoides in India. Among Tor species Tor putitora (Hamilton) is the most widely distributed Mahseer in Pakistan and other countries of the Indian subcontinent. However, based alone on morphological characters some authors identify the Pakistani counterparts as Tor macrolepis (Heckel), (a species presumed to be found exclusively in the Indus River system) distinct from Tor putitora (a species found in Ganga Brahmaputra River system). In order to resolve this taxonomic ambiguity, present study carried out meristic and morphometric measurements of Mahseer collected from a total of 11 water bodies of Pakistan. Ratios between the morphometric characters were calculated and statistically analyzed using t-test and correlation coefficient. Two species identified as Tor putitora and Naziritor zhobensis were the sole Mahseer inhabitants of Indus system in Pakistan. Tor putitora occurred at all surveyed sites while Nazirtor zhobensis had a distribution range from river Zhob to tributaries of river Gomal the right bank tributaries of River Indus. The study corroborates that there are no unequivocal morphological synapomorphies in any existing populations of both species. The study further demonstrates that head length, a character frequently used in Mahseer taxonomy, is not a good measure for species identification. Finally the present study establishes that Naziritor zhobensis still exists in the water bodies of Pakistan and that golden Mahseer occurring in Indus riverine system of Pakistan is Tor putitora.

No sul e sudeste da Ásia, três gêneros de espécies de peixes, ou seja, Tor, Neolissochilus e Naziritor, são comumente conhecidos como Mahseer com pelo menos 47 espécies. Entre estas, 23 pertencem ao gênero Tor, 22 a Neolissochilus e um a Naziritor, ou seja, Naziritor zhobensis. Recentemente, outra espécie adicionada ao gênero Naziritor é Naziritor chelynoides na Índia. Entre as espécies de Tor, Tor putitora (Hamilton) é o Mahseer mais amplamente distribuído no Paquistão e em outros países do subcontinente indiano. No entanto, com base apenas em caracteres morfológicos, alguns autores identificam as contrapartes paquistanesas como Tor macrolepis (Heckel) (uma espécie que se presume ser encontrada exclusivamente no sistema do rio Indo), distinta de Tor putitora (uma espécie encontrada no sistema do rio Ganga Brahmaputra). A fim de resolver essas ambiguidades taxonômicas, o presente estudo realizou medidas merísticas e morfométricas de Mahseer coletadas em um total de 11 corpos d’água do Paquistão. As razões entre os caracteres morfométricos foram calculadas e analisadas estatisticamente usando o teste t e o coeficiente de correlação. Duas espécies identificadas como Tor putitora e Naziritor zhobensis foram os únicos habitantes Mahseer do sistema fluvial Indo no Paquistão. Tor putitora ocorreu em todos os locais pesquisados, enquanto Nazirtor zhobensis tinha uma faixa de distribuição do rio Zhob aos afluentes do rio Gomal, afluentes da margem direita do rio Indo. O estudo corrobora que não há sinapomorfias morfológicas inequívocas em nenhuma das populações existentes de ambas as espécies. O estudo demonstra ainda que o comprimento da cabeça, um caractere frequentemente usado na taxonomia de Mahseer, não é boa medida para identificação das espécies. Finalmente, o presente estudo estabelece que Naziritor zhobensis ainda existe nos corpos d'água do Paquistão e que o Mahseer dourado ocorrendo no sistema fluvial Indo do Paquistão é Tor putitora.

An overview of the taxonomic instability of endangered Golden and Zhobi mahseer in Pakistan

Abstract In South and South East Asia three genera of fish species i.e. Tor, Neolissochilus and Naziritor are commonly known as Mahseer with at least 47 species. Among these 23 belongs to genus Tor, 22 to Neolissochilus and one to Naziritor i.e. Naziritor zhobensis. Recently another species added to genus Naziritor is Naziritor chelynoides in India. Among Tor species Tor putitora (Hamilton) is the most widely distributed Mahseer in Pakistan and other countries of the Indian subcontinent. However, based alone on morphological characters some authors identify the Pakistani counterparts as Tor macrolepis (Heckel), (a species presumed to be found exclusively in the Indus River system) distinct from Tor putitora (a species found in Ganga Brahmaputra River system). In order to resolve this taxonomic ambiguity, present study carried out meristic and morphometric measurements of Mahseer collected from a total of 11 water bodies of Pakistan. Ratios between the morphometric characters were calculated and statistically analyzed using t-test and correlation coefficient. Two species identified as Tor putitora and Naziritor zhobensis were the sole Mahseer inhabitants of Indus system in Pakistan. Tor putitora occurred at all surveyed sites while Nazirtor zhobensis had a distribution range from river Zhob to tributaries of river Gomal the right bank tributaries of River Indus. The study corroborates that there are no unequivocal morphological synapomorphies in any existing populations of both species. The study further demonstrates that head length, a character frequently used in Mahseer taxonomy, is not a good measure for species identification. Finally the present study establishes that Naziritor zhobensis still exists in the water bodies of Pakistan and that golden Mahseer occurring in Indus riverine system of Pakistan is Tor putitora.

Resumo No sul e sudeste da Ásia, três gêneros de espécies de peixes, ou seja, Tor, Neolissochilus e Naziritor, são comumente conhecidos como Mahseer com pelo menos 47 espécies. Entre estas, 23 pertencem ao gênero Tor, 22 a Neolissochilus e um a Naziritor, ou seja, Naziritor zhobensis. Recentemente, outra espécie adicionada ao gênero Naziritor é Naziritor chelynoides na Índia. Entre as espécies de Tor, Tor putitora (Hamilton) é o Mahseer mais amplamente distribuído no Paquistão e em outros países do subcontinente indiano. No entanto, com base apenas em caracteres morfológicos, alguns autores identificam as contrapartes paquistanesas como Tor macrolepis (Heckel) (uma espécie que se presume ser encontrada exclusivamente no sistema do rio Indo), distinta de Tor putitora (uma espécie encontrada no sistema do rio Ganga Brahmaputra). A fim de resolver essas ambiguidades taxonômicas, o presente estudo realizou medidas merísticas e morfométricas de Mahseer coletadas em um total de 11 corpos dágua do Paquistão. As razões entre os caracteres morfométricos foram calculadas e analisadas estatisticamente usando o teste t e o coeficiente de correlação. Duas espécies identificadas como Tor putitora e Naziritor zhobensis foram os únicos habitantes Mahseer do sistema fluvial Indo no Paquistão. Tor putitora ocorreu em todos os locais pesquisados, enquanto Nazirtor zhobensis tinha uma faixa de distribuição do rio Zhob aos afluentes do rio Gomal, afluentes da margem direita do rio Indo. O estudo corrobora que não há sinapomorfias morfológicas inequívocas em nenhuma das populações existentes de ambas as espécies. O estudo demonstra ainda que o comprimento da cabeça, um caractere frequentemente usado na taxonomia de Mahseer, não é boa medida para identificação das espécies. Finalmente, o presente estudo estabelece que Naziritor zhobensis ainda existe nos corpos dágua do Paquistão e que o Mahseer dourado ocorrendo no sistema fluvial Indo do Paquistão é Tor putitora.

Monitoring pond water quality to improve the production of Labeo rohita (Hamilton, 1822) in Bannu Fish Hatchery of Bannu district, Khyber Pakhtunkhwa province; An Implications for artificial fish culture

Abstract The water quality parameters of a fish pond are essential to be managing properly under control for successful operations of fish culture. Improper management of pond water quality during the juvenile stages can create stressful conditions to produce various harmful diseases, which may decrease the fish quality and results in low profits. The present study was aimed to monitored important water quality parameters of nursery ponds of Labeo rohita culturing in Bannu fish hatchery. The study duration was 75 days extends from 10th June to 24th August 2019 for the successful culture of this specie which can play a significant role in breeding season. Furthermore, the concentration of some heavy metals like copper (Cu), nickel (Ni), manganese (Mn), iron (Fe), cadmium (Cd), and zinc (Zn) in pond water and fry stages of this species was also determined. The data obtained from all water quality parameters were analyzed expressed as range, mean and standard deviation using MS Excel 2013. The obtained results of 75 days study revealed that the water pH & temperature, electric conductivity, total dissolved solids (TDS), and total dissolved oxygen (DO) of pond water samples were found within a tolerable limit except salinity and dissolved ammonia concentration were not permissible for fish growth. The average concentration of heavy metals in pond water exhibited descending order Fe>Ni>Mn>Zn>Cd>Ni, which was found in acceptable ranges. Whereas, the average values of heavy metals in fry stages were in the order of Zn>Fe>Ni>Cu>Cd>Mn, and found within the recommended values of WHO/FAO. Thus, it was concluded from this study that good water quality is a precondition, maintaining balanced levels of water quality parameters is fundamental for both the health and growth of fish culture which is quite necessary for assuring increased fish productivity. It is recommended to monitor and assess water quality parameters on a routine basis for promoting healthy fish culture.

Resumo Os parâmetros de qualidade da água de um viveiro de peixes são essenciais para um manejo adequado e sob controle para operações bem-sucedidas de piscicultura. O manejo inadequado da qualidade da água do tanque durante os estágios juvenis pode criar condições estressantes para a produção de várias doenças nocivas, o que pode diminuir a qualidade do peixe e resultar em baixos lucros. O presente estudo teve como objetivo monitorar importantes parâmetros de qualidade da água de viveiros de cultivo de Labeo rohita em incubadora de peixes Bannu. A duração do estudo foi de 75 dias, estendendo-se de 10 de junho a 24 de agosto de 2019 para o sucesso do cultivo dessa espécie que pode desempenhar papel significativo na época de reprodução. Além disso, a concentração de alguns metais pesados como cobre (Cu), níquel (Ni), manganês (Mn), ferro (Fe), cádmio (Cd) e zinco (Zn) na água do tanque e estágios de fritura dessa espécie também foram determinados. Os dados obtidos de todos os parâmetros de qualidade da água foram analisados expressos como faixa, média e desvio padrão usando o MS Excel 2013. Os resultados obtidos de 75 dias de estudo revelaram que o pH e temperatura da água, condutividade elétrica, sólidos totais dissolvidos (TDS) e total de oxigênio dissolvido (OD) das amostras de água do lago foram encontrados dentro de um limite tolerável, exceto salinidade e concentração de amônia dissolvida não eram permitidas para o crescimento dos peixes. A concentração média de metais pesados na água da lagoa apresentou ordem decrescente Fe > Ni > Mn > Zn > Cd > Ni, que foi encontrada em faixas aceitáveis. Já os valores médios dos metais pesados nos estágios de fritura foram da ordem de Zn > Fe > Ni > Cu > Cd > Mn, e encontrados dentro dos valores recomendados pela OMS/FAO. Assim, concluiu-se deste estudo que a boa qualidade da água é uma condição prévia, manter níveis equilibrados dos parâmetros de qualidade da água é fundamental para a saúde e crescimento da piscicultura, o que é bastante necessário para garantir o aumento da produtividade piscícola. Recomendam-se monitorar e avaliar os parâmetros de qualidade da água em uma base rotineira para promover a piscicultura saudável.

Local spectroscopic evidence for a nodeless magnetic kagome superconductor CeRu2.

We report muon spin rotation (µSR) experiments on the microscopic properties of superconductivity and magnetism in the kagome superconductor CeRu2withTc≃5 K. From the measurements of the temperature-dependent magnetic penetration depthλ, the superconducting order parameter exhibits nodeless pairing, which fits best to an anisotropics-wave gap symmetry. We further show that theTc/λ-2ratio is comparable to that of unconventional superconductors. Furthermore, the powerful combination of zero-field (ZF)-µSR and high-fieldµSR has been used to uncover magnetic responses across three characteristic temperatures, identified asT1∗≃110 K,T2∗≃65 K, andT3∗≃40 K. Our experiments classify CeRu2as an exceedingly rare nodeless magnetic kagome superconductor.

Predictors of citation rates for research publications in Neurosciences.

OBJECTIVES: To identify the predictors of citation rates for research publication in Neurosciences. METHODS: All original articles including meta-analyses (MAs) and systematic reviews (SRs) that were published in Neurosciences during 2011 to 2019 were reviewed. The impact of several predictors on citation rates was assessed using correlation coefficient and mean difference tests. RESULTS: This study examined 231 articles. The mean article citation number was 11.6. The correlation analysis showed a significant association between citation rates and duration from publication in years (p<0.0001), sample size (p<0.0001), study design (p=0.0353), and level of evidence (LOE) (p=0.03). The comparative analysis showed significantly more citations for articles that were published 6-10 years ago (p<0.0001), had a sample size >91 (p=0.0359), were randomized controlled trials (p=0.0353), MAs and SRs (p<0.0001), and level of evidence (LOE)-I (p=0.0004). Retrospective case series had significantly lower citations. The higher and lower citation numbers for publications from Iran and rehabilitation, respectively, may have been influenced by the duration from publication. CONCLUSION: The most significant predictors of citation rates for Neurosciences publications were the age of articles, population size, study design, and LOE. Awareness of the predictors of citation rates may help researchers enhance the academic impact of their work.

Monitoring pond water quality to improve the production of Labeo rohita (Hamilton, 1822) in Bannu Fish Hatchery of Bannu district, Khyber Pakhtunkhwa province; An Implications for artificial fish culture.

The water quality parameters of a fish pond are essential to be managing properly under control for successful operations of fish culture. Improper management of pond water quality during the juvenile stages can create stressful conditions to produce various harmful diseases, which may decrease the fish quality and results in low profits. The present study was aimed to monitored important water quality parameters of nursery ponds of Labeo rohita culturing in Bannu fish hatchery. The study duration was 75 days extends from 10th June to 24th August 2019 for the successful culture of this specie which can play a significant role in breeding season. Furthermore, the concentration of some heavy metals like copper (Cu), nickel (Ni), manganese (Mn), iron (Fe), cadmium (Cd), and zinc (Zn) in pond water and fry stages of this species was also determined. The data obtained from all water quality parameters were analyzed expressed as range, mean and standard deviation using MS Excel 2013. The obtained results of 75 days study revealed that the water pH & temperature, electric conductivity, total dissolved solids (TDS), and total dissolved oxygen (DO) of pond water samples were found within a tolerable limit except salinity and dissolved ammonia concentration were not permissible for fish growth. The average concentration of heavy metals in pond water exhibited descending order Fe>Ni>Mn>Zn>Cd>Ni, which was found in acceptable ranges. Whereas, the average values of heavy metals in fry stages were in the order of Zn>Fe>Ni>Cu>Cd>Mn, and found within the recommended values of WHO/FAO. Thus, it was concluded from this study that good water quality is a precondition, maintaining balanced levels of water quality parameters is fundamental for both the health and growth of fish culture which is quite necessary for assuring increased fish productivity. It is recommended to monitor and assess water quality parameters on a routine basis for promoting healthy fish culture.

Prevalence of Binge-Eating Disorder and Its Association with Nicotine Dependence Among Under-Graduate Students at a Saudi Public University.

PURPOSE: There is minimal information regarding the prevalence of binge-eating disorders in Saudi Arabia. This study aims to measure the prevalence of BED and its association with nicotine dependency (ND) among undergraduate university students at Imam Mohammad Ibn Saud Islamic University (IMSIU). METHODS: A cross-sectional study recruited 878 participants, with an inclusion criteria that encompassed all IMSIU undergraduate students of either sex. The online-based self-report questionnaire was distributed through e-mail, which used the Binge-Eating Disorder Screener-7 (BEDS-7) to evaluate BED symptoms and the Fagerstrom Test of Nicotine Dependence (FTND) to measure the levels of ND. The e-FTND version was also adapted into the questionnaire to account for modern methods of nicotine usage. RESULTS: A total of 165 participants were BED positive, with a prevalence of 18.8%, 99 of whom were women, and 66 were men. Women were significantly more predicted for BED than men (p = 0.035). Men appeared to be mainly more expected to be nicotine dependent (p < 0.001). BED positive participants showed a higher probability of being nicotine dependent than BED negative participants in the multivariate logistic regression analysis (95% CI 1.3-3.2; p = 0.002). CONCLUSION: BED prevalence was notably high compared to worldwide estimates, with a significant association to nicotine dependence by the multivariate analysis. In the future, more investigations regarding the prevalence of specific types of eating disorders, including BED, in Saudi Arabia need to be considered.

An overview of the taxonomic instability of endangered Golden and Zhobi mahseer in Pakistan.

In South and South East Asia three genera of fish species i.e. Tor, Neolissochilus and Naziritor are commonly known as Mahseer with at least 47 species. Among these 23 belongs to genus Tor, 22 to Neolissochilus and one to Naziritor i.e. Naziritor zhobensis. Recently another species added to genus Naziritor is Naziritor chelynoides in India. Among Tor species Tor putitora (Hamilton) is the most widely distributed Mahseer in Pakistan and other countries of the Indian subcontinent. However, based alone on morphological characters some authors identify the Pakistani counterparts as Tor macrolepis (Heckel), (a species presumed to be found exclusively in the Indus River system) distinct from Tor putitora (a species found in Ganga Brahmaputra River system). In order to resolve this taxonomic ambiguity, present study carried out meristic and morphometric measurements of Mahseer collected from a total of 11 water bodies of Pakistan. Ratios between the morphometric characters were calculated and statistically analyzed using t-test and correlation coefficient. Two species identified as Tor putitora and Naziritor zhobensis were the sole Mahseer inhabitants of Indus system in Pakistan. Tor putitora occurred at all surveyed sites while Nazirtor zhobensis had a distribution range from river Zhob to tributaries of river Gomal the right bank tributaries of River Indus. The study corroborates that there are no unequivocal morphological synapomorphies in any existing populations of both species. The study further demonstrates that head length, a character frequently used in Mahseer taxonomy, is not a good measure for species identification. Finally the present study establishes that Naziritor zhobensis still exists in the water bodies of Pakistan and that golden Mahseer occurring in Indus riverine system of Pakistan is Tor putitora.

Leprosy patients with deformities at post-elimination stage: The Bangladesh experience.

Background: Disability assessment in leprosy patients is a very important factor in the evaluation of the effectiveness of a leprosy elimination program. Little information exists on deformities in leprosy patients in Bangladesh. Objectives: To describe the pattern and prevalence of deformities in leprosy patients after leprosy has been declared eliminated from Bangladesh in 1998. Methods: A descriptive retrospective cross-sectional study was carried out in Chittagong Medical College Hospital using the registered records of patients for the period 2004-2013. Results: Out of 670 leprosy patients, 213 (31.79%) had deformities. The prevalence of deformity was for grade 1: 92 (43.20%), for grade 2: 121 (56.80%). Among the patients with deformity, males 144 (67.60%) outnumbered females 69 (32.40%). Four age groups were considered. The calculated age-specific cumulative detection rates showed the highest case detection in >40 years group at 81 (38.02%). The rate of children (<14 years) was less at 7 (3.29%). Of the 213 patients with deformity, the borderline tuberculoid patients were totalled 79 (37.08%), which was higher than other forms of leprosy. Among the 121 patients with limb deformity, 57 (8.50%) had claw hand followed by wrist drop 31 (4.63%), foot drop 30 (4.48%). Three (0.45%) had a nerve abscess, 27 (4.02%) had a trophic ulcer and 7 (1.05%) patients had ocular complications. Conclusion: The grade 2 deformities among newly detected leprosy patients were still high. Claw hand was the most common deformity in the upper limbs, whereas foot drop and trophic ulcer were the most common deformities in the lower limbs. Although leprosy according to the World Health Organization has been eliminated globally, the disease continues to be a significant cause of peripheral neuropathy, deformity, disability and disfigurement in some developing countries like Bangladesh.

Biocontrol efficacy of Trichoderma asperellum-enriched coconut fibre against Fusarium wilts of cherry tomato.

AIMS: Agro-based wastes were evaluated as a medium for mass micropropagule production and optimal efficacy of Trichoderma asperellum B1092 in controlling Fusarium oxysporum f. sp. lycopersici and promoting tomato growth. This study focused on biological control because pathogen persistence in the soil makes the disease difficult to control. METHODS AND RESULTS: Rice bran, biochar, empty fruit bunches, coconut fibres, compost, top soil and mixed soil were evaluated as media for mass multiplication of T. asperellum, which is effective in controlling plant pathogens. Yielding the most colony forming units (CFU) among the media, coconut fibre was deemed most suitable for promoting sporulation. After 120 days on the medium, T. asperellum B1902 produced 9·053 × 105  CFU per gram coconut fibre; oil palm empty fruit bunches was second highest (7·406 × 105  CFU per gram). In field tests of T. asperellum B1092 against F. oxysporum f. sp lycopersici (causing Fusarium wilt of cherry tomato), B1092 significantly promoted plant growth compared to the control. The efficacy of this formulation resulted in increased growth of roots and shoots tomato plants and total lycopene, sugar, K, N, Ca, P and Mg content after 120 days. CONCLUSIONS: Trichoderma asperellum B1092 showed great field potential for improving productivity and quality of tomatoes and in controlling Fusarium wilt of cherry tomato. SIGNIFICANCE AND IMPACT OF THE STUDY: This innovative approach using a cheap agro-waste to control the persistent soil-borne Fusarium pathogen of cherry tomato should increase soil survival rate of Trichoderma and has potential for upscaling in the field for other crops.

Physiological changes in the size of the septal swell body correlate with changes in inferior turbinate size.

OBJECTIVE: The nasal septal swell body is a normal anatomical structure located in the superior nasal septum anterior to the middle turbinate. However, the impact of the septal swell body in nasal breathing during normal function and disease remains unclear. This study aimed to establish that the septal swell body varies in size over time and correlates this with the natural variation of the inferior turbinates. METHOD: Consecutive patients who underwent at least two computed tomography scans were identified. The width and height of the septal swell body and the inferior turbinates was recorded. A correlation between the difference in septal swell body and turbinates between the two scans was performed using a Pearson's coefficient. RESULTS: A total of 34 patients (53 per cent female with a mean age of 58.3 ± 20.2 years) were included. The mean and mean difference in septal swell body width between scans for the same patient was 1.57 ± 1.00 mm. The mean difference in turbinate width between scans was 2.23 ± 2.52 mm. A statistically significant correlation was identified between the difference in septal swell body and total turbinate width (r = 0.35, p = 0.04). CONCLUSION: The septal swell body is a dynamic structure that varies in width over time in close correlation to the inferior turbinates. Further research is required to quantify its relevance as a surgical area of interest.

Patient preferences for topical treatment of actinic keratoses: a discrete-choice experiment.

BACKGROUND: The treatment of actinic keratosis (AK) is a potentially effective strategy for the prevention of cutaneous squamous cell carcinoma (cSCC). However, the patient perspective on potential benefits of AK treatment in terms of skin cancer reduction has received little attention to date. OBJECTIVES: (i) To investigate patient preferences for topical treatments for AK using a discrete-choice experiment (DCE); (ii) to evaluate patient willingness to trade between clinical benefit and medical burden. METHODS: The DCE was conducted as part of a study to establish the feasibility of a phase III randomized controlled trial evaluating the prevention of cSCC using currently available topical interventions. Preferences were elicited by asking patients to make a series of choices between treatment alternatives with different hypothetical combinations of attribute levels. Willingness to trade between treatment attributes was estimated using a flexible-choice model that allows for the heterogeneity of patient preferences. RESULTS: A total of 109 patients with AK completed the DCE. The majority of patients who expressed valid preferences were willing to accept some reduction in both prophylactic and cosmetic efficacy to reduce the burden of the treatment regimen, the severity of skin reaction and other adverse effects. Patients may reject treatment if the perceived therapeutic benefit is outweighed by the subjective burden of treatment. CONCLUSIONS: Evidence of significant variation in the perceived utility of treatments across patients highlights the importance of taking individual patient preferences into account to improve AK treatment acceptability and adherence.

Randomized Controlled Trial of Slow Versus Rapid Enteral Feeding Advancements on the Clinical Outcomes in Very Low Birth Weight Neonates.

Starting and advancement of feeding in very low birth weight (VLBW) infants are big challenges for the neonatal practitioners. Wide variations in volume of feed advancement have observed in earlier trials both in slow and rapid advancement groups. Volume advancement in slow advancement groups have ranged from 10ml/kg/day to 23ml/kg/day and in rapid advancement groups have ranged from 15ml/kg/day to 45ml/kg/day in earlier different studies. This randomized controlled trial was conducted in neonatal intensive care unit (NICU) of Bangabandhu Sheikh Mujib Medical University (BSMMU) from April 2013 to July 2014 to evaluate the effects of slow versus rapid rates of feeding advancements on the clinical outcomes in very low birth weight infants. A total 95 infants were enrolled into two strata according to their birth weight. Infants of each stratum were randomly allocated to either slow or rapid advancement group during initiation of feeding. After gut priming over five days, feeding was advanced daily 10ml/kg in slow and 15ml/kg in rapid advancement group for 1000 - <1250gm weighing infants. For 1250 - <1500gm weighing infants, feeding was advanced daily 15ml/kg in slow and 20ml/kg in rapid advancement group. The primary outcome variable was time taken to achieve full enteral feed. Total 82 infants completed the trial. Demographically both groups were same. Infants in the rapid feeding advancement group achieved full enteral feedings before the slow advancement group, had significantly fewer days of parenteral nutrition and regained birth weight earlier. There were no statistical differences in episodes of feed interruption, number of infants with apnea, feed intolerance or diagnosis of sepsis. Rapid enteral feeding advancements were well tolerated by very low birth weight infants.

Systematic review and meta-analysis of the complications of salvage total laryngectomy.

BACKGROUND AND OBJECTIVES: Management paradigms in laryngeal cancer have shifted to "organ preservation" chemoradiotherapy protocols. In the event of treatment failure, salvage total laryngectomy remains the only curative treatment option. However a comprehensive review of the complications of this procedure has not been reported. METHODS: A systematic review of the literature was performed using keywords "salvage laryngectomy" to retrieve relevant publications between January 2000 and August 2015. RESULTS: Of the 407 articles retrieved from the literature search, 50 studies encompassing 3292 patients were included. Forty-nine studies reported pharyngocutaneous fistula which occurred in 859 patients (pooled incidence 28.9%; 95% confidence intervals 25.5-32.5%). Twenty-four studies reported complications in addition to PCF and these included wound complications (infection, dehiscence and necrosis), dysphagia, bleeding, and pharyngeal and stomal stenosis. CONCLUSIONS: Overall complication rate was 67.5%, Pharyngocutaneous fistula was the commonest complication with a pooled incidence of 28.9%.

Osteopenia of Prematurity: Are We at Risk?

The continuous advances in intensive care have led to increased survival of premature infants. As a consequence, the problem of less imminent, slowly progressing disorders such as osteopenia of prematurity has been emerging. Osteopenia of prematurity (OOP) also called metabolic bone disease of prematurity (MBD) or rickets of prematurity is characterized by a reduction in bone mineral content usually manifest between 6th to 12th weeks of corrected gestational age. It occurs in up to 55% of infants born with weight <1000gm and 23% of infants weighing <1500gm. Clinical features of osteopenia of prematurity are mostly non-specific often appears as a late symptoms. Several biochemical markers have frequently been used as screening tools and diagnostic markers, but timing of measurements and the levels at which treatment should be initiated vary widely. Dual energy X-ray absorptiometry (DEXA) and Quantitative ultrasnogram are important diagnostic tool. Standard X-ray, a widely accepted but cannot detect osteopenia unless 20% loss of bone mineralization. The treatment of osteopenia includes provision of adequate mineral supplementation. Monitoring of serum and urinary markers are mandatory. The focus on prevention has largely centered on providing adequate intake of phosphorus and calcium but more research is needed. Till date there are neither enough data regarding clinical risk factors, valid biochemical markers which can detect premature babies at risk of osteopenia nor supplementation as well as appropriate timely management protocol is practicing in Bangladesh.