A generalized algorithm for the automatic diagnosis of sleep apnea from per-sample encoding of airflow and oximetry.

Objective. Sleep apnea is a common sleep breathing disorder that can significantly decrease sleep quality and have major health consequences. It is diagnosed based on the apnea hypopnea index (AHI). This study explored a novel, generalized algorithm for the automatic diagnosis of sleep apnea employing airflow (AF) and oximetry (SpO2) signals.Approach. Of the 988 polysomnography records, 45 were randomly selected for developing the automatic algorithm and the remainder 943 for validating purposes. The algorithm detects apnea events by a per-sample encoding process applied to the peak excursion of AF signal. Hypopnea events were detected from the per-sample encoding of AF and SpO2with an adjustment to time lag in SpO2. Total recording time was automatically processed and optimized for computation of total sleep time (TST). Total number of detected events and computed TST were used to estimate AHI. The estimated AHI was validated against the scored data from the Sleep Heart Health Study.Main results. Intraclass correlation coefficient of 0.94 was obtained between estimated and scored AHIs. The diagnostic accuracies were 93.5%, 92.4%, and 96.6% for AHI cut-off values of ≥5, ≥15, and ≥30 respectively. The overall accuracy for the combined severity categories (normal, mild, moderate, and severe) and kappa were 83.4% and 0.77 respectively.Significance. This new automatic technique was found to be superior to the other existing methods and can be applied to any portable sleep devices especially for home sleep apnea tests.

Anorectal Malformations and Associated Anomalies in Children.

Anorectal malformations (ARM) incorporate a broad spectrum of diseases, can affect both sexes, and involve the distal anus and rectum as well as the uro-genital tracts. Defects range from the minor which can be treated easily with an excellent outcome, to those are complex and often associated with other anomalies are difficult to manage with poor functional prognosis. This study was done to observe the hospital incidence of Anorectal malformations, frequency of types, sex distribution and spectrum of associations with ARM. The effects of presence of associated anomalies on morbidity and mortality also observed. Detailed history, clinical examinations and relevant investigations were performed for the primary and as well as the associated anomalies. A total of 80 patients were admitted in the department of pediatric surgery in Mymensingh Medical College Hospital during the period of June 2016 to May 2017. Age of the patients was ranging from 1-180 days with the mean age of 0.49±1.002 months. Male: Female ratio was 1.6: 1. Among them 48(60%) were high and 32(40%) were low variety of ARM. In male 37(46.2%) had high and 13(13.7%) were low variety whereas in female 11(13.7%) were high and 19(23.7%) had low ARM. Associated anomalies were seen in 25(31.2%) patient -18 in males and 7 in females; 20 in high and 5 in low ARM. Associated anomalies were uro-genital 11(13.8%), cardiovascular 10(12.5%), vertebral 4(5%), limb defects 3(3.5%) and others 2(2.5%). Four patients have more than one anomaly. Anorectal malformations occur more in boys than girls. Males were more likely to have high lesions and without fistula was the common defect. Low variety ARM were found more in females with Anovestibular fistula is the commonest defect. The most common associated anomalies were recto urinary fistula (13.8%). Associations were more in high than low ARM but not significant (p>0.05). Post operative complications were more in high ARM in both sexes with associated anomalies. The effects of types and associations on morbidity and mortality were significantly different (p<0.05).

A novel algorithm for automatic diagnosis of sleep apnea from airflow and oximetry signals.

OBJECTIVE: Sleep apnea significantly decreases the quality of life. The apnea hypopnea index (AHI) is the main indicator for sleep apnea diagnosis. This study explored a novel automatic algorithm to diagnose sleep apnea from nasal airflow (AF) and pulse oximetry (SpO2) signals. APPROACH: Of the 988 polysomnography (PSG) records from the sleep heart health study (SHHS), 45 were randomly selected for the development of an algorithm and the remainder for validation (n = 943). The algorithm detects apnea events by a digitization process, following the determination of the peak excursion (peak-to-trough amplitude) from AF envelope. Hypopnea events were determined from the AF envelope and oxygen desaturation with correction to time lag in SpO2. Total sleep time (TST) was estimated from an optimized percentage of artefact-free total recording time. AHI was estimated from the number of detected events divided by the estimated TST. The estimated AHI was compared to the scored SHHS data for performance evaluation. MAIN RESULTS: The validation showed good agreement between the estimated and scored AHI (intraclass correlation coefficient of 0.95 and mean ±95% limits of agreement of -1.6 ±12.5 events h-1). The diagnostic accuracies were found: 90.7%, 91%, and 96.7% for AHI cut-off ≥5, ≥15, and ≥30 respectively. SIGNIFICANCE: The new algorithm is accurate over other existing methods for the automatic diagnosis of sleep apnea. It is applicable to any portable sleep screeners especially for the home diagnosis of sleep apnea.

Study of Risk Factors, Causative Organisms & Their Sensitivity Pattern in Neonatal Sepsis in a Community Based Tertiary Level Hospital.

Neonatal sepsis is one of the most common reasons for admission to neonatal units in developing countries. It is also a major cause of mortality in both developed and developing countries. The type and pattern of organisms that cause neonatal sepsis changes over time and vary from one hospital to another hospital, even in the same country. In addition the causative organisms have developed increased drug resistance for the last two decades. Maternal, neonatal and environmental risk factors have contributed for the development of sepsis. To study the risk factors, causative organism and bacterial sensitivity pattern in cases of neonatal sepsis. This cross-sectional study was conducted over a period of six months. The study included 100 patients admitted at the neonatal ward of Department of Pediatrics, Community Based Medical College Bangladesh, Mymensingh, Bangladesh. Blood samples for culture were taken aseptically before starting antibiotic therapy. Microorganisms were isolated and identified by standard microbiological processes and antimicrobial sensitivity patterns were performed against amikacin, gentamicin, ceftriaxone, ciprofloxacin and ceftazidime. The factors which carried a significant risk for development of neonatal sepsis were low birth weight, preterm neonates, meconium stained liquor and prolonged rupture of membrane (>18 hours). Gram negative organisms predominated (68.8%) with Escherichia coli (33.3%) being the commonest. The gram negative bacteria which were isolated sensitive to amikacin, gentamicin and ceftriaxone. The organisms also relatively more sensitive to ciprofloxacin and highly sensitive to ceftazidime. The Gram positive bacteria showed sensitivity against only the antibiotic Ceftriaxone and Ciprofloxacin. The overall mortality was 9%. The outcome of the study will contribute to preventing and treating neonatal sepsis in the hospital.

Results of Locking Compression Plate (LCP) Fixation in Humeral Shaft Nonunion.

Although nonoperative treatment is indicated & successful for the majority of diaphyseal humeral fractures, nonunion is not rare condition. The prevalence of nonunion as a complication of conservative treatment has been reported to be as high as 15%. Locking compression plate combined with autogenous cancellous bone grafting can result in reliable healing of these humeral nonunion with excellent functional outcome. This prospective observational study was conducted September, 2016 to October, 2018 at National Institute of Traumatulogy & Orthopaedic Rehablitation, Dhaka & Mymensingh Medical College, Mymensingh, Bangladesh. Fifteen (15) patients with non-united humeral shaft fractures were treated by open reduction and internal fixation by LCP with autogenous cancellous bone graft. Detailed clinical conditions of all patients, duration of injury, technical difficulty with the implant, hospital stay period were recorded. Follow up period was 6 months. The patients were evaluated clinically and radiologically for outcomes. The progresses of healing as well as occurrence of complications were recorded. The modified Constant and Murley score of functional assessment was used for shoulder & elbow function. Age of the study patients was ranged 20-50 years. Maximum patients were male 12. Mode of injury were found road traffic accident 8 cases, fall from height 5 cases. Right side was injured in 9 patients. Atrophic nonunion was found in 13 patients and hypertropic in 2 patients. The mean union time was 15 weeks. Only one patient had wound infection and 2 patients had shoulder stiffness. Functional outcome which constituted 90% satisfactory results in 13 cases according to modified Constant & Murley scoring system. Union rate was 100%. Therefore, LCP fixation with autogenous cancellous bone graft is a standard treatment method for nonunion of humeral shaft fracture.

Renal Involvement as a Presenting Feature of Multiple Myeloma.

Renal involvement may be the presenting feature in a vast majority of patients with multiple myeloma and is one of the key for clinical manifestations of symptomatic multiple myeloma. The purpose of the study was to find out the pattern of renal involvement at the time of presentation of multiple myeloma and to explore its association with clinical, laboratory and pathologic features of these cases. This cross sectional study was conducted in the Department of Nephrology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from February 2016 to September 2017. Forty seven (47) patients of newly diagnosed multiple myeloma having renal involvement were included in the study. Multiple myeloma was diagnosed as per criteria proposed by the International Myeloma Working Group, 2003. Renal involvement was considered to be present when any one of proteinuria, microscopic haematuria, renal impairment or urinary tract infection (UTI) was found in the patient. Renal biopsy was done in suitable patients under ultrasound guidance after taking informed written consent. The pattern of renal involvement was detected and status of renal function was assessed and its clinical, laboratory and pathologic associations were analyzed. Data were managed by using computer based software, the Statistical Package for Social Sciences (SPSS) version 23 (IBM Corp.). Median age at presentation was 59 years with the range of 37-76 years. Female (53.2%) was slightly predominant than male (46.8%) and male to female ratio was 1:1.14. Renal impairment, microscopic haematuria, proteinuria, nephrotic range proteinuria, urinary Bence Jones protein and UTI were found in 70%, 19%, 79%, 25%, 19% and 17% of patients respectively. Median serum creatinine and proteinuria were 256µmol/l and 1.24gm/day. Hypercalcaemia and Bence Jones proteinuria were detected in 36% and 27% of patients respectively with renal impairment which were statistically significant. The precipitating factors for renal impairment were NSAIDs use (67%), hyperuricaemia (49%), hypercalcaemia (36%), dehydration (27%), UTI (18%) and no identifiable factor (3%). Dialysis was required in 15% new myeloma patient. Renal biopsy and histopathological examination revealed myeloma cast nephropathy (30%), amyloidosis (30%), glomerulosclerosis (chronic kidney disease) (20%), monoclonal immunoglobulin deposition disease (MIDD) (10%) and interstitial nephritis with fibrosis (10%). Renal involvement was a common and severe complication of multiple myeloma. Renal impairment was strongly associated with hypercalcaemia, NSAIDs use, hyperuricaemia, Bence Jones proteinuria etc.

Incidence of Negative Appendicectomy in Clinically Diagnosed Patients of Acute Appendicitis.

This study was conducted in the department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2016 to December 2017 and performed to assess the negative appendicectomy on histopathology followed by clinically and laboratory investigations based diagnosed acute appendicitis. To perform this prospective study 200 patients with pain in right iliac fossa of both sexes randomly selected and were evaluated by history, clinical examination, laboratory investigations (USG, CBC) and scoring system. Among 200 patients male 124 and female 76 under went appendicectomy 36 were histopathologically normal appendix. Over all negative appendicectomy (NAR) 18%, among them 14.5% (18/124) were male & 23.67% (18/76) were female.

High Transverse Scrotal Incision Orchiopexy for Undescended Testes.

Bianchi squire first described scrotal incision orchiopexy as an alternative to the traditional approach in the1980s. In maximum premature and some mature infants, palpable testis is a common surgical problem. There are several surgical technique applied to overcome this surgical problems like combined inguinal and scrotal incision or single high transverse scrotal incision. The goal of this study assessed single high transverse scrotal incision for the management of PUT as regards to evaluate operative time, postoperative success and final cosmetic results. One hundred twenty patients were managed at the Paediatric Surgery Department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh with PUT during the period from 2015 to March 2018. We operated all cases between 6 to 12 months and excluded more than 12 months of age and recurrent cases. This technique involves manipulation of the testis down to the scrotum so that it is secured between the thumb and index finger as a fixation is performed. After fixation of testis high transverse scrotal incision was given, all layers were separated. Then enter into inguinal cannel by cutting of external ring. After dissecting the testis come down through the incision. After making dartos pouch through the same incision and orchidopexy done. All infants were followed-up at 1 month, 2 months and 6 months to detect operative times as well as position, testicular atrophy and the final cosmetic appearance. Patient age ranged from 6 months to 12 months. A total of 120 PUTs were operated upon in 100 patients. PUT was bilateral in 15 patients, right-sided in 55 cases and left-sided in 30 cases. Among 120 testes 40 testes were located distal to external inguinal ring (EIR), 70 testes were at internal inguinal ring (IIR) and 10 testes were in between EIR and IIR. A total of 100 patients were successfully placed within scrotum using a single incision. Operative time ranged from 20-36 minutes. There were no cases of testicular atrophy or ascent. The only complications were 3 wound infections (3%), which were successfully treated with antibiotics. Single high transverse scrotal incision was sufficient to deal with PUT especially, in young infants (age 6 months). The procedure results in shorter operative times, similar success and complication rates, and a more cosmetically appealing outcome compared to inguinal orchiopexy.

Assessment of Number and Distribution of Mast Cell in Oral Squamous Cell Carcinoma in Biopsy Specimen and Its Correlation with Histological Grading.

Oral cancer is a commonly occurring one worldwide. More than 90% of all oral cancers are squamous cell carcinoma (SCC). The molecular biological markers of oral SCC have been extensively studied to aid in prevention and prognosis. However, no marker has been universally accepted so far. Mast cells are important component of cancer stromal interaction. Their early recruitment in tumor microenvironment and multifarious function make them a burning topic of interest in the field of research. So mast cell may act as a new target for the adjuvant treatment of oral SCC. Therefore, the aim of the study was to compare the number and distribution of mast cell between different grades of oral SCC. In this cross sectional study the sample size was 100. After routine tissue processing and staining with Hematoxylin & Eosin (H/E) stains, slides of all cases were grouped as- well, moderate and poorly differentiated invasive squamous cell carcinoma according to Anneroth's grading system. Identification of mast cell was done by Toluidine blue stain. Distribution of mast cells was observed and number of mast cells was counted. The data was tabulated and statistical analysis was performed. Out of 100 cases, 66% patients belonged to Grade I, 28% Grade II and 6% Grade III. The mean±SD number of mast cells was 3.28±1.21, 1.59±0.58 and 0.44±0.17 in Grade I, Grade II and Grade III SCC, respectively. The p value was found to be highly significant (p<0.001). An inverse significant Pearson's correlation was found between number of mast cells and grades of oral SCC. The number of mast cell was slightly increased in oral SCC cases than normal. The number of mast cells also had an inverse association with histologic grade. So, in this observation mast cell is a good cellular indicator of tumor grade.

Laparoscopic Adrenalectomy: Two Years Experience at Bangabandhu Sheikh Mujib Medical University.

Laparoscopic surgery has become an efficient tool for many complex surgical procedures. In last decades, laparoscopic adrenalectomy has become a more viable option for removal of adrenal pathology, with many surgeons preferring it to the conventional open technique. This study was done to evaluate the outcomes of lateral transperitoneal adrenalectomy (LTA) in our department and evaluate the feasibility of lateral transperitoneal adrenalectomy (LTA) in our perspective. This study is case series observational study carried out at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2015 to May 2017. Suspected primary adrenal malignancies were excluded. Seventeen (17) patients (10 male and 7 females with mean age of 35.29 years) underwent 18 adrenalectomy (one bilateral). Seventeen (17) adrenal tumours were resected through laparoscopy and one adrenal tumour is resected through open approach due to conversion. All the patients underwent hormonal evaluation, ultrasonogram and computed tomography of whole abdomen. Ten (10) patients (58.82%) had hormonal active adrenal mass. Seven (7) patients (41.18%) were asymptomatic of which 2 had associated cholelithiasis, 7 patients had generalized weakness, 3 had weight gain with Cushing syndrome (one drug induced) and one had Hirsutism with musculanizing effect. Nine (9) patients had hypertension and 6 patients had diabetes mellitus. Eight (8) right, 8 left and 1 bilateral LTA were performed. The mean age of the patients were 35.29 years, adrenal tumour size ranges from 15-65mm and operation time ranges from 75-120 minutes for unilateral adrenalectomies and 220 minutes for bilateral adrenalectomy. Estimated blood loss ranges from 30 to 130 ml in 16 cases and in one case it was 220 ml in which conversion was done. Mean post operative stay in hospital was 3.94 days. In 16 cases no major or minor complications were observed but in one case due to haemorrhage and infiltration of the tumour to kidney conversion are done in the form of right adrenalectomy with upper partial nephrectomy (Histopathology revealed angiomyolipoma). In pathological examination 9 patients (52.94%) had adrenocortical adenoma, 2 patients (11.76%) had phaeochromocytoma including bilateral one, 2 patients (11.76%) had myolipoma of which one converted to open, 2 patients (11.76%) had adrenocortical hyperplasia, one patient (5.88%) had adrenal cyst and one patient (5.88%) had haemorrhagic cyst. LTA is a safe and efficient minimally invasive treatment options for both secreting and non secreting adrenal masses. The procedure has a learning curve and should be performed by a surgeon experienced in both open and laparoscopic adrenal surgery.

Classification methods to detect sleep apnea in adults based on respiratory and oximetry signals: a systematic review.

OBJECTIVE: Sleep apnea (SA), a common sleep disorder, can significantly decrease the quality of life, and is closely associated with major health risks such as cardiovascular disease, sudden death, depression, and hypertension. The normal diagnostic process of SA using polysomnography is costly and time consuming. In addition, the accuracy of different classification methods to detect SA varies with the use of different physiological signals. If an effective, reliable, and accurate classification method is developed, then the diagnosis of SA and its associated treatment will be time-efficient and economical. This study aims to systematically review the literature and present an overview of classification methods to detect SA using respiratory and oximetry signals and address the automated detection approach. APPROACH: Sixty-two included studies revealed the application of single and multiple signals (respiratory and oximetry) for the diagnosis of SA. MAIN RESULTS: Both airflow and oxygen saturation signals alone were effective in detecting SA in the case of binary decision-making, whereas multiple signals were good for multi-class detection. In addition, some machine learning methods were superior to the other classification methods for SA detection using respiratory and oximetry signals. SIGNIFICANCE: To deal with the respiratory and oximetry signals, a good choice of classification method as well as the consideration of associated factors would result in high accuracy in the detection of SA. An accurate classification method should provide a high detection rate with an automated (independent of human action) analysis of respiratory and oximetry signals. Future high-quality automated studies using large samples of data from multiple patient groups or record batches are recommended.

Caesarean of Lion (Panthera leo) at Dulahajra Safari Park, Bangladesh.

A six years eight months pregnant lioness at the Dulahajara Safari Park, Chakoria, Cox's Bazar, Bangladesh, was presented with dystocia. This paper described the pre-, intra- and postoperative procedures including anesthetic protocol carried out and performing a caesarean section to remove dead fetuses and the successful recovery of the lioness without complications.