A photocatalyst-free visible-light-mediated solvent-switchable route to stilbenes/vinyl sulfones from ß-nitrostyrenes and arylazo sulfones.

Photocatalyst-free visible-light-mediated reactions, based on the presence of a visible-light-absorbing functional group in the starting material itself in order to exclude the often costly, hazardous, degradable and difficult to remove or recover photoredox catalysts, have been gaining momentum recently. We have employed this approach to develop a denitrative photocatalyst-free visible-light-mediated protocol for the arylation/sulfonylation of ß-nitrostyrenes employing arylazo sulfones (bench-stable photolabile compounds) in a switchable solvent-controlled manner. Arylazo sulfones served as the aryl and sulfonyl radical precursors under blue LED irradiation for the synthesis of trans-stilbenes and (E)-vinyl sulfones in CH3CN and dioxane/H2O 2 : 1, respectively. The absence of any metal, photocatalyst and additive; excellent selectivity (E-stereochemistry) and solvent-switchability; and the use of visible light and ambient temperature are the prime assets of the developed method. Moreover, we report the first photocatalyst-free visible light-driven route to synthesize stilbenes and vinyl sulfones from readily available ß-nitrostyrenes.

The role of bacterial skin infections in atopic dermatitis: expert statement and review from the International Eczema Council Skin Infection Group.

Patients with atopic dermatitis (AD) have an increased risk of bacterial skin infections, which cause significant morbidity and, if untreated, may become systemic. Staphylococcus aureus colonizes the skin of most patients with AD and is the most common organism to cause infections. Overt bacterial infection is easily recognized by the appearance of weeping lesions, honey-coloured crusts and pustules. However, the wide variability in clinical presentation of bacterial infection in AD and the inherent features of AD - cutaneous erythema and warmth, oozing associated with oedema, and regional lymphadenopathy - overlap with those of infection, making clinical diagnosis challenging. Furthermore, some features may be masked because of anatomical site- and skin-type-specific features, and the high frequency of S. aureus colonization in AD makes positive skin swab culture of suspected infection unreliable as a diagnostic tool. The host mechanisms and microbial virulence factors that underlie S. aureus colonization and infection in AD are incompletely understood. The aim of this article is to present the latest evidence from animal and human studies, including recent microbiome research, to define the clinical features of bacterial infections in AD, and to summarize our current understanding of the host and bacterial factors that influence microbial colonization and virulence.

Organic photoredox catalysis enabled cross-coupling of arenediazonium and sulfinate salts: synthesis of (un)symmetrical diaryl/alkyl aryl sulfones.

We disclose herein the first transition-metal- and external oxidant/reductant-free visible-light-mediated synthesis of (un)symmetrical diaryl/alkyl aryl sulfones from arenediazonium tetrafluoroborates and sodium sulfinates using eosin Y as an organic photoredox catalyst. The utilization of visible light as an inexpensive and ecosustainable energy source, operational simplicity, ambient temperature and clean reaction in aqueous acetonitrile are the salient features of the developed protocol. The desired sulfones were also synthesized via a one-pot, two-step process directly from anilines and sulfinate salts in good to excellent yields.

Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement.

BACKGROUND: Guidelines discourage the use of systemic corticosteroids for atopic dermatitis (AD), but their use remains widespread. OBJECTIVES: To reach consensus among an international group of AD experts on the use of systemic corticosteroids for AD. METHODS: A survey consisting of statements accompanied by visual analogue scales ranging from 'strongly disagree' to 'neutral' to 'strongly agree' was distributed to the International Eczema Council (IEC). Consensus was reached in agreement on a statement if < 30% of respondents marked to the left of 'neutral' towards 'strongly disagree'. RESULTS: Sixty of 77 (78%) IEC members participated. Consensus was reached on 12 statements, including that systemic corticosteroids should generally be avoided but can be used rarely for severe AD under certain circumstances, including a lack of other treatment options, as a bridge to other systemic therapies or phototherapy, during acute flares in need of immediate relief, in anticipation of a major life event or in the most severe cases. If used, treatment should be limited to the short term. Most respondents agreed that systemic corticosteroids should never be used in children, but consensus was not reached on that statement. The conclusions of our expert group are limited by a dearth of high-quality published evidence. If more stringent consensus criteria were applied (e.g. requiring < 20% of respondents marking towards 'strongly disagree'), consensus would have been reached on fewer statements. CONCLUSIONS: Based on expert opinion from the IEC, routine use of systemic corticosteroids for AD is generally discouraged and should be reserved for special circumstances.

Posterior polar cataract: Minimizing risks.

BACKGROUND: Comparing surgical outcomes of management of posterior polar cataract, a congenital cataract, which is difficult to manage surgically and has been associated with poor surgical outcomes. METHODS: 46 eyes of 38 patients with posterior polar cataract underwent phacoemulsification and PCIOL implantation. RESULTS: In a prospective analytical study, 46 eyes of 38 patients with posterior polar cataracts underwent surgery at a zonal hospital of the armed forces. The posterior polar cataract incidence was 1.23 per 1000 with confidence interval (CI) of 0.0012. Of the 46 eyes operated, 6 had a posterior capsular rupture (PCR) (13.04%). The PCR incidence in normal cataracts is reported at approx. 1.1%, whereas, various studies have reported incidence of 6-36% in posterior polar cataracts. 41 eyes achieved a visual acuity of 6/12 or better (89.13%) and 39 eyes of 6/9 or better (84.78%). 4 patients had amblyopia (8.6%), Two patients developed macular edema (4.34%). Mean follow-up was 7 months (range 3-11 months). There was no case of nucleus drop or retinal detachment. CONCLUSION: Posterior polar cataracts are a surgical challenge. With controlled surgery, well defined techniques, a good surgical outcome can be achieved with reduced incidence of PCR.

Autism spectrum disorders: a qualitative study of attitudes toward prenatal genetic testing and termination decisions of affected pregnancies.

In the United States, prenatal genetic testing (PGT) for Autism Spectrum Disorders (ASD) is currently available via clinical genetic services. Such testing may inform parents about their unborn child's risk for ASD, prepare parents for the birth of an affected infant, and allow them to arrange for early interventions. Although PGT for autism has potential benefits, the associated ethical, legal, and social implications (ELSI) should be considered. This first qualitative study employed a hypothetical scenario to explore the attitudes toward PGT and termination decisions of 42 parents of children with ASD. Over half of the participants expressed willingness to undergo PGT for autism. Reasons included better preparation for birth, early and better treatment, termination of affected pregnancy, contribution to research, and curiosity. Of the 31 parents who were either willing or unsure about undergoing the PGT, approximately three-fourths would continue their hypothetical affected pregnancies. Explanations included preparation for birth of the child, bonding or acceptance of existing ASD-affected children, apprehensions about test limitations, and religious concerns. Parents who reported they would terminate the affected pregnancy in this hypothetical situation were primarily Asians. This study contributes to the growing understanding of the ELSI aspects of PGT in clinical practice.

Autism spectrum disorders: perceptions of genetic etiology and recurrence risk among Taiwanese parents of affected children.

In Taiwan, autism spectrum disorders (ASDs) are an emerging public health concern. The ongoing scientific progress for understanding the genetic etiology of ASD makes it increasingly important to examine how parents of children with ASD perceive the causes and recurrence risk of having another child with ASD. These perceptions may influence their family planning, attitudes toward genetic services, and willingness to take their children for ASD genetic testing. However, previous studies addressing this issue were conducted primarily in Western countries. As culture might shape an individual's views of genetic/genomic disorders, this first-of-its-kind study examined the perceptions of the genetic etiology for ASD and the recurrence risk among Taiwanese parents of children affected with ASD. In-depth, semi-structured interviews were conducted among 39 parents having at least one child with ASD. Although the majority of participants believed that ASD has a genetic link, less than half perceived genetic factors as the cause of their own child's ASD. Moreover, most participants articulated their recurrence risk incorrectly. Some parents were concerned about their doctors' limited genomic competencies. To provide parents with better education, counseling, and support for making reproductive decisions, ASD-related genomic education among Taiwanese physicians is needed.

Direct construction of 2-alkylbenzo-1,3-azoles via C-H activation of alkanes for C-C and C-X (X = O, S) bond formation.

Copper catalyzed straightforward synthesis of 2-alkylbenzoxa(thia)azoles from aryl isocyanates/isothiocyanates and simple alkanes is reported. The protocol utilizes ditertiary butyl peroxide (DTBP) as a radical initiator and involves sequential formation of C-C and C-X (X = O, S) bonds followed by aromatization in a one-pot procedure.

Obstetric Outcome in Early and Late Onset Gestational Diabetes Mellitus.

Obstetric outcome in early onset and late onset GDM was compared in a prospective study conducted at the Department of Obstetrics & Gynecology in BIRDEM, Dhaka, Bangladesh. A total 120 pregnant women were recruited purposively for the study in which 60 were early onset GDM and 60 were late onset GDM during study period of January 2008 to December 2009. Patients were followed up in different periods of gestation, during delivery and early postpartum period & findings were compared between two groups. BMI & family history of diabetes were significantly higher in early GDM group (p<0.05). Evidence of increased glycaemia was observed in early GDM group & difference of glycaemic status was statistically significant (p<0.05). Insulin was needed in 85% of early onset GDM and 55% in late onset GDM. There was also significant difference (p<0.05). In this study, 23.3% of early onset GDM group developed pre-eclampsia while in late onset GDM it was 10% and was statistically significant (p<0.05). Regarding intrapartum & postpartum complications - perineal tear, PPH wound infection, puerperal sepsis were more in early onset than late onset GDM group with no significant difference. Regarding foetal outcome, 8.3% early GDM group delivered asphyxiated baby in comparison to 3.3% in late GDM group. Twenty percent (20%) of early onset GDM group had to admit their babies in neonatal unit while in late onset group it was 5%. There was significant difference between two groups (p<0.05). Neonatal hypoglycaemia was also statistically significantly (p<0.05) higher in early GDM group. Neonatal hyper-bilirubinaemia, RDS, perinatal death was more in early onset GDM subjects. Early onset GDM subjects are high risk subgroup & have significant deleterious effect on maternal and perinatal outcome than late GDM groups.

Attitude and Practices of Mothers on Breastfeeding Attended at a Tertiary Hospital in Bangladesh.

This descriptive cross sectional study was conducted in Pediatric Out Patient Department (OPD) of Mymensingh Medical College Hospital (MMCH) from November 2013 to April 2014 to assess the knowledge and practices of the mothers about breastfeeding. Four hundred mothers having children 6 months to 2 years of age attended at OPD of MMCH for any cause were included in the study by systematic random sampling. A structured, pre-tested, interview schedule was used to collect data from mothers. All mothers were continuing to breastfeed their children. Two hundred and seventy-two (68.00%) infants received breast feeding within 1 hour after birth, while 128(32.00%) infants received breast feeding after 1 hour of birth. Of 128, in 48(37.50%) cases, mother's illness was the reason for delay in initiation of breast feeding, whereas in 70(54.69%) cases, it was due to reduced milk production on mother's statement. Pre-lacteal feeding was given in 96(24.00%) children. Among them honey was given in 24(25.00%) cases, cow's milk was given in 14(14.58%) cases, sugar water was given in 18(18.75%) cases and formula milk was given in 40(41.67%) cases. One hundred and twenty-eight (32.00%) mothers started to give their child food other than breast milk before 3 months of age and 148(37.00) mothers started to give their child food other than breast milk before 6 months of age. The reason for starting to give their child food other than breast milk before 6 months of age was mother's assumption of milk insufficiency in 166(60.14%) cases and baby's cry for hunger in 110(39.86%) cases. Formula milk was given in 120(30.00%) infants before 6 months of age. Among them 96(80.00%) mothers prepared it with larger amount of water. Plain water was given in 240(60.00%) children before the age of 6 months. One hundred and twenty-four (31.00%) children were exclusively breastfeed for first 6 months of age. Breastfeeding is almost universal in Bangladesh but the exclusive breastfeeding rate is alarmingly very low. Great emphasis is needed to educate mothers about benefits of colostrum, exclusive breastfeeding, and the harmful effects of pre-lacteal feeding.

Knowledge and practices of mothers on childhood diarrhoea and its management attended at a tertiary hospital in bangladesh.

This descriptive cross sectional study was conducted in Pediatric out Patient Department (OPD) of Mymensingh Medical College Hospital (MMCH) from March 2014 to August 2014 to assess the knowledge and practices of the mothers in acute diarrhoeal diseases in children under-five years of age regarding use of oral rehydration solution (ORS), zinc, other drugs and feeding practices. Four hundred children under-five years of age having acute diarrhoea were included in the study by systematic random sampling. A structured, pretested, interviewer-administered questionnaire was used to collect data from mothers of children having diarrhoeal diseases. ORS was offered by 360(90.00%) of the mothers. Out of which 279(77.50%) used it by their own knowledge. One hundred and ninety-one (53.06%) mothers prepared it correctly, while 169(46.94%) prepared it incorrectly. Of 169, 129(35.83%) mothers used less amount of water, while 40(11.11%) mothers used much amount of water to prepare ORS. Of 360 mothers, 89(24.72%) mixed part of the content of ORS sachet at a time. Of 360 mothers, only 55(15.28%) offered correct amount of ORS after each purging. Zinc was offered in 142(35.50%) children. Of 400, only 13(3.25%) mothers used recommended home-based fluid, while 70(17.50%) mothers offered increased amount of fluid to their child. Drugs other than zinc and ORS were used in 247(61.75%) children. Among drugs, other than zinc and ORS, antibiotics was used in 109(44.13%) cases, whereas antiprotozoal in 97(39.27%) cases. Amount of liquid given was more than usual in 70(17.50%) children, same as usual in 57(14.25%) children and less than usual in 273(68.25%) children. Amount of food given was same as usual in 59(14.75%) children, while less than usual in 341(85.25%) children. Control of diarrhoeal diseases programme is successful in introducing ORS at mass level. Great emphasis is needed to educate mothers about preparation and quantity of ORS to be given to children with diarrhoeal diseases.

Aerobic oxysulfonylation of alkenes using thiophenols: an efficient one-pot route to ß-ketosulfones.

We have developed a highly efficient synthetic route to ß-ketosulfones via AgNO3 catalyzed oxysulfonylation of alkenes using thiophenols in the presence of air (O2) and K2S2O8 as eco-friendly oxidants. Thiophenols have been used as sulfonylation precursors for the first time in a dioxygen activation based radical process. Moreover, the protocol also offers a new and convenient method for the synthesis of ß-hydroxysulfides at room temperature without the use of any initiator.

Valence band structure of InAs(1-x)Bi(x) and InSb(1-x)Bi(x) alloy semiconductors calculated using valence band anticrossing model.

The valence band anticrossing model has been used to calculate the heavy/light hole and spin-orbit split-off energies in InAs(1-x)Bi(x) and InSb(1-x)Bi(x) alloy systems. It is found that both the heavy/light hole, and spin-orbit split E + levels move upwards in energy with an increase in Bi content in the alloy, whereas the split E - energy for the holes shows a reverse trend. The model is also used to calculate the reduction of band gap energy with an increase in Bi mole fraction. The calculated values of band gap variation agree well with the available experimental data.

Effects of nebulized budesonide as an adjunct to standard treatment of asthma exacerbations: a randomized, double-blind, placebo-controlled trial.

This study was done to determine the effects and outcome of inhaled budesonide in addition to standard management of asthma exacerbations in pediatric age groups. A randomized, double-blind, placebo controlled trial was done in a tertiary care urban hospital. Sixty six children aged 5 to 15 years with moderate to severe asthma exacerbations were eligible. All patients received a single dose of prednisolone 1mg/kg orally as first dose of systemic corticosteroids and then salbutamol (0.15mg/kg) and ipratropium bromide (500mcg) was nebulized every 20 minutes for 3 doses and then hourly for 2 hours as a part of standard treatment of asthma exacerbations. The intervention was 2mg (4mL) of budesonide or 4mL of normal saline which was nebulized immediately after the 1st dose of nebulized salbutamol and ipratropium bromide. The baseline characteristics of the budesonide group (n=33) and placebo group (n=33) were similar, but at 1 hour, 2 hour and 3 hour PEFR, respiratory rate, pulse rate, SaO2 and asthma score were significantly improved in the budesonide group compared to placebo group (p<0.01). The positive immediate effect of nebulized budesonide added to standard treatment of asthma exacerbations is an encouraging finding for further investigations of its routine use in the treatment of asthma exacerbations in children.

Endometrial Thickness as a Predictor of Endometrial Malignancy among the Women Presenting with Abnormal Uterine Bleeding.

Abnormal uterine bleeding (AUB) is the most common and frequent presenting complaint in Gynaecology in all age group especially in perimenopausal and postmenopausal women. The spectrum of AUB in women of our country includes a wide varieties of organic pathology. The objective of this study was to assess the role of endometrial thickness as a predictor of endometrial malignancy among the women presenting with AUB. This cross-sectional descriptive type of observational study was conducted among 122 women of perimenopausal (40-50 years) and 87 women of postmenopausal (>50 years) age group presenting with AUB in the Obstetrics and Gynaecology department of Mymensingh Medical College Hospital, Bangladesh from February 2020 to August 2021. These patients were subjected to a detailed history and meticulous general, systemic and local examination. The relevant investigations like Transvaginal Sonography (TVS) followed by endometrial biopsy by dilatation and curettage were done in all study participants. Most of the women were in the age group 41-45 years in perimenopause and 51-55 years in postmenopause. Mean±SD was 45.8±4.1 years in perimenopause and 56.3±6.4 years in postmenopause. There was statistical significance in developing endometrial malignancy regarding risk factors of nulliparity, Hypertention (HTN), Diabetes mellitus (DM) and hormone intake between perimenopause and postmenopause. Endometrial thickness was measured in perimenopause and postmenopause. Mean±SD of Endometrial thickness (ET) in perimenopause and postmenopause was 11.3±4.4mm and 7.2±6.3mm with statistical significance (p<0.001). Sensitivity, specificity, Positive predictive value (PPV), Negative predictive value (NPV) and accuracy of TVS were 85.5%, 67.4%, 81.2%, 73.8% and 78.7% in perimenopause and 85.9%, 20%, 89%, 75% & 83.9% in postmenopause. Cut off limit of ET in detection of endometrial malignancy was 18.5mm with sensitivity 74.8% and specificity 63.6% in perimenopause and 12.2mm with sensitivity 81.0% and specificity 65.8% in postmenopausal women. Women with AUB, endometrial malignancy should be suspected when endometrial thickness on TVS >18.5mm and >12.2mm in perimenopause and postmenopausal age group respectively. TVS has high sensitivity in detection of endometrial malignancy both in perimenopausal and postmenopausal women with AUB and TVS is a reliable, noninvasive method.

Indication and Post-operative Complication of Primary Caesarean Section in Multiparous Women in A Tertiary Level Hospital.

The spectrum of indications for primary caesarean section changes with advancing parity. As parity advances more cesarean section are done for maternal rather than fetal indications. The objective of this study was to determine the indications and complications of caesarean section in multiparous women with history of previous vaginal delivery. This cross-sectional descriptive observational study was conducted in Mymensingh Medical College Hospital from January 2019 to June 2019 among 100 purposively selected multiparous women who underwent primary caesarean section. A well-designed, semi-structured questionnaire was used to collect data by face-to-face interview, clinical examinations and laboratory investigations. Data analysis was conducted in SPSS 20.0 version. Majority (74.0%) of the women in this study were in the age group 21-30 years with mean age of 26.3±5.76 years. Majority of the patients were of second gravida (42.0%) followed by third gravida (33.0%). The highest gravida in this study was 6th. Most of the patients were of para 1(44.0%). Highest para in this study was para 5. The most common indication of caesarean section in this study was foetal distress (26.0%). The next common indications were cephalo-pelvic disproportion (22.0%), antepartum haemorrhage (13.0%), mal-presentaion or mal-position (16.0%). Other causes were PROM (8.0%), prolonged labour (6.0%), cord prolapse (2.0%), post-dated pregnancy (4.0%), severe pre-eclampsia (2.0%) and secondary subfertility (1.0%). There was no case of maternal mortality in this study but 15 mothers suffered from various post-operative complications like wound infection (4.0%), UTI (4.0%), puerperal pyrexia (3.0%), postpartum haemorrhage (3.0%) and paralytic ileus (1.0%). Among the babies delivered 97 were live births. Among the 97 live births 11(11.34%) were preterm babies. Among the babies delivered majority (85.0%) was with good APGAR score (7-10). In conclusion it can say that a multiparous women in labour requires the same attention as that of primigravida. A parous women needs good obstetric care to improve maternal and neonatal outcome and still keeping caesarean section to a lower rate.

Analysis of Socio Demographic Risk Factors of Cervical Intraepithelial Neoplasia at Colposcopic Clinic in Mymensingh Medical College Hospital.

Cervical intraepithelial neoplasia (CIN) is a pre-malignant lesion of the cervix of uterus. Several risk factors increased the risk of developing CIN. Purpose of this study was to evaluate the socio-demographic risk factors related to CIN at our setting. This Cross sectional observational study was performed at Colposcopic clinic of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from 9th November 2017 to 8th May 2018. Overall demographic features of 50 patients of precancerous cervical lesion show that, most of the patients belonged to the age group 30-39 years (46.0%), mean age was 32.7±10.3 years. Maximum numbers of respondents came from rural area (58.0%), followed by urban area (42.0%). Among them house wife- 46.0%, daily worker- 30.0% and illiterate 36.0%, primary level of education 32.6%. Among the patients the poor class 46.0% and 58.0% of the respondents were married at age ≤19 year. Among the respondents, (26.0%) were conceived their first child 1 month after their marriage and 54.0% of the women within 12 months of marriage. In this study multipara were (62.0%). Oral contraceptive pill was taken by (42.0%) of patients. The association of risk factors revealed that betel or tobacco chewing present in 28.0% cases; history of menstrual regulation (MR), dilatation, evacuation and curettage (DE&C), miscarriage were in 26.0% cases, family history of cancer were in 16.0% cases and multiple sexual exposure was in 10.0% cases. Women develop pre-malignant cervical lesions require early treatment. It is recommended that provision of proper health care support, early detection of CIN and proper management, can reduce the fatal outcome of the disease.

Endoscopic ultrasound-guided fine needle aspiration training: evaluation of a new porcine lymphadenopathy model for in vivo hands-on teaching and training, and review of the literature.

BACKGROUND AND STUDY AIMS: Adequate training is required to achieve successful endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA). Of the variety of training models currently available, none offers verisimilitude to the tactile feel of puncturing a human lymph node. The aim of the current study was to evaluate a new porcine lymph node model for EUS-FNA training and to evaluate its impact on trainees' performance in patients compared with the literature of other models available. METHODS: Two trainees each performed EUS-FNA of 96 lymph nodes in 18 animals with induced lymphadenopathy (mean 1.6 cm [range 0.9-3.5 cm]). Accuracy, speed, adequacy of sampling, and trainees' performance pre- and post-training were measured. Using a questionnaire, data were gathered regarding the effect of training and comfort level in patients. Results were compared with those in the literature. RESULTS: Trainees progressed from hands-on assistance to occasional verbal guidance toward the end of animal training. There was good correlation between puncture time and number of EUS-FNA procedures performed in all but the subcarinal location (r = - 0.17). Comparison of trainee performance in patients before and after training showed a reduction in puncture time (P = 0.0014). Questionnaire analysis revealed increased confidence in echoendoscope- and needle-handling. Comparison with other published models supports these results. CONCLUSION: Results from the literature and the current study showed that animal training improves trainee performance, confidence, and procedural comfort when returning to patient examinations. The new model produces a realistic response that is similar to EUS-FNA in patients; this experience provides a benefit to endoscopists in terms of improved performance in patients and could be considered for use in accreditation. Due to the small numbers of trainees, larger experiences are needed to confirm training efficacy.

Double balloon enteroscopy: Bangladesh experience.

Double balloon enteroscopy (DBE) is a newly developed endoscopic modality for diagnosis and treatment of small bowel disorders. The aim of this study was to evaluate the diagnostic and therapeutic impact of DBE in patient with suspected small bowel disease. This was a prospective study. Sixty one double balloon enteroscopy procedures (30 antegrade 31 retrograde) were done in thirty six patients (20M/16F, mean age 40 ± 12.5 range 16-65 years ) at gastroenterology department, Sir Salimullah Medical College, Dhaka between October 2011 and September 2012. Indications for DBE included chronic abdominal pain 14 (38.9%), obscure GI bleeding 11 (30.56%), Small bowel obstruction 05 (13.89%), and chronic diarrhea 06 (16.67%). The morphologic findings were ulcerations 13 (36.11%), growth 03 (8.33%), vascular ectasia 03 (8.33%) and polyp 01 (2.78%). Therapeutic interventions were performed in one patient only. No serious complications were observed. Diagnostic yields in case of chronic abdominal pain, chronic diarrhea, obscure GI bleeding and small bowel obstruction were 50%, 66%, 63% and 40% respectively. The findings were adenocarcinoma 04 (11%), lymphoma 03 (8.4%), tuberculosis 03 (8.4%), non specific findings 05 (13.9%), IPSID 01(2.8%), Crohn's disease 01 (2.8%), vascular ectasia 03 (8.33%) and normal 16 (44.44%). DBE is well tolerated, feasible and useful technique for the diagnosis as well as treatment of small intestinal disorders.

Relationship between Clinical Profile, Severity and Outcome of Community Acquired Pneumonia with Hyponatremia in Children Aged 2-60 Months.

Hyponatremia is the most common electrolyte imbalance seen in clinical practice and a common laboratory findings in children with community acquired pneumonia. This study aimed to find out relationship between clinical profile, severity and outcome of community acquired pneumonia with hyponatremia in children aged 2-60 months. This descriptive cross-sectional study was done in pediatrics department of Mymensingh Medical College Hospital, Bangladesh. Study period was 6 month from November 2016 to April 2017. Data were collected from 2 months to 60 months old children who fulfill the selection criteria. In this study sampling technique was purposive. Detailed history was taken, and meticulous examinations and relevant investigations were performed. 100 patients with community acquired pneumonia were enrolled, 34.0% patient had hyponatremia and 66.0% patients had no hyponatremia. Hyponatremia is more marked (45.5%) in severe pneumonia followed by moderate pneumonia (33.3%) and no hyponatremia found in mild pneumonia. Mean temperature, respiratory rate, heart rate, head nodding, nasal flaring, grunting, stridor, cyanosis, convulsion, feeding problem, Poor air entry were significantly higher in patient of pneumonia with hyponatremia when compared to patient of pneumonia without hyponatremia. Mean duration of symptoms and mean duration of hospital stay were also significantly higher in patient of pneumonia with hyponatremia. The mean serum sodium concentration was 132.18±1.51mmol/L in hyponatremic patients and 137.91±1.94mmol/L in normonatremic patients. Mean values of total leucocyte count, ESR, and C-reactive protein were significantly higher in patient of pneumonia with hyponatremia. Serum hemoglobin was significantly lower in hyponatremic patients than normonatremic patients. Maximum (55.9%) patients of community acquired pneumonia (CAP) with hyponatremia had patchy opacity, 26.5% had consolidation, 11.8% had interstitial opacity and 5.9% had pneumatocele. All the patients were treated with appropriate antibiotics and fluid and discharged after complete recovery without any complication. There was no death in the study population. From this study we can conclude that, hyponatremia is directly related with the severity of community acquired pneumonia (CAP). The intensity of clinical profile and investigation findings are also directly related with the severity of pneumonia.