How many melanomas might be prevented if more people applied sunscreen regularly?

BACKGROUND: Ultraviolet radiation causes cutaneous melanoma. Sunscreen prevents sunburn and protects skin cells against mutations. High-quality epidemiological studies suggest regular sunscreen use prevents melanoma. OBJECTIVES: To calculate the potential impact fraction (PIF) for melanoma in the U.S.A. and Australia assuming a range of different intervention scenarios intended to increase sunscreen use. METHODS: We calculated the PIF, the proportional difference between the observed number of melanomas arising under prevailing levels of sunscreen use compared with the number expected under counterfactual scenarios. We used published melanoma incidence projections for Australia and the white population in the U.S.A. from 2012 through to 2031 as the baseline condition, with estimates for protective effects of 'regular sunscreen use' from the literature. Sunscreen prevalence was sourced from national or state surveys. RESULTS: Under a plausible public health intervention scenario comprising incremental increases in sunscreen prevalence over a 10-year implementation programme, we estimated that cumulatively to 2031, 231 053 fewer melanomas would arise in the U.S. white population (PIF 11%) and 28 071 fewer melanomas would arise in Australia (PIF 10%). Under the theoretical maximum model of sunscreen use, almost 797 000 (PIF 38%) and approximately 96 000 (PIF 34%) melanomas would be prevented in the U.S.A. and Australia, respectively between 2012 and 2031. A sensitivity analysis using weaker effect estimates resulted in more conservative PIF estimates. CONCLUSIONS: Overall, interventions to increase use of sunscreen would result in moderate reductions in melanoma incidence, assuming no compensatory overexposure to the sun. Countries with a high incidence of melanoma should monitor levels of sunscreen use in the community.

Exceptional Multiple Foreign-Body Ingestion by a Patient with Schizophrenia.

Swallowing foreign body in adult is uncommon. This mostly occurs accidentally or in psychologically unsound patient. A 32-years-old male patient with abdominal pain admitted in surgery department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh with a history of swallowing various objects. After endoscopic confirmation and psychological evaluation he underwent laparotomy and 29 different objects were removed from his stomach by Gastrotomy. He was psychiatrically evaluated after recovery from operation and was found to be suffering from Schizophrenia with cannabis use. The aim of reporting this case can raise awareness at the patients complains should be taken seriously to prevent morbidity and even mortality.

Serum LDL (Low Density Lipoprotein) As a Risk Factor for Ischemic Stroke.

Atherosclerosis is the main risk factor of ischaemic stroke. Dyslipidaemia is the main cause of atherosclerosis. High levels of LDL, also called "bad" cholesterol, seem to provoke stroke. This case control study was conducted in Mymensingh Medical College Hospital during the period of January 2012 to December 2012. The study was carried out to measure the level of serum LDL (Low Density Lipoprotein) of ischaemic stroke patients admitted in Medicine wards of Mymensingh Medical College Hospital and the result of this study was compared with the level of LDL cholesterol in age matched controls. Sample size was 384 which had been selected by inclusion and exclusion criteria. Out of 384 samples 192 were cases and 192 were controls. Mean age ±SD was 57.0±10.85 years in cases and 57.43±10.64 years in controls. Elderly people are the most vulnerable group for developing stroke. LDL cholesterol level was more than 130mg/dl was found 88.54% among cases and 33.85% among controls, the difference was statistically significant (p<0.05). Mean LDL level ±SD were 145±13.59mg/dl in cases and 125.01±10.73mg/dl in controls. Odds ratio of LDL cholesterol were 15.0979 and 95% confidence limits were 8.8396 to 25.7869 among cases and controls. This study explored study population with higher LDL cholesterol was over fifteen times more likely to developed ischaemic stroke. Early detection of high LDL cholesterol in the way to prevent ischaemic stroke and thereby reduced the morbidity and mortality of ischaemic stroke.

Small Bowel Perforation during Suprapubic Trocar Cystotomy: A Case Report.

A 35 years old man presented with retention of urine secondary to meatal stenosis with bulbar urethral stricture. He had a distended, palpable, tender urinary bladder. Urethral catheterization and dilatation was tried but failed. A trocar cystostomy was performed under local anaesthesia, which led to the injury to the small bowel when least expected. This is a rare but well recognized complication of small bowel injury following blind trocar suprapubic cystostomy when it was least expected and as such had a significant bearing on its management. We discuss its subsequent management and possible mechanism underlying this unexpected and unfortunate complication in the given circumstances.

Early Outcome of Primary Repair in Colonic Injury.

The management of the colon injury remains controversial in spite of a number of divergent reports during the past decade. Previously surgeons were reluctant to do primary anastomosis but now-a-days they are doing primary repair with good results. The present study is designed to see the early outcomes of primary repair in colonic injury. This prospective observational study performed at Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2013 to June 2013 with allocation of 50 patients with colonic injury who underwent laparotomy with primary repair of that injury in the department of Casualty Surgery. A primary repair was performed after freshening the edges or by resection and primary anastomosis with 3.0 round-body Vicryl by single layer extra mucosal interrupted suture. Data processed using software SPSS version 16.0. For all analytical results a p value <0.05 was considered significant. In this study the commonest site of injury were transvers colon and sigmoid colon 38.0% in each. Out of 50 respondents, 5(10.0%) developed burst abdomen, 1(2.0%) developed entero-cutaneous fistula with none had paralytic ileus or septicaemia or pelvic collection. No mortality observed. This study showed that the increasing in colon injury scale (CIS) score culminate into increasing rate of postoperative complication & post operative complications were more at left colon (24%). On basis of our findings, we recommend the primary repair is a safe and effective surgical technique for addressing the large gut injury. Unnecessary proximal diversions should be avoided. According to our experience, we believe that the policy of primary repair of colon injuries can be applied more liberally in majority of patients with high success rate.

Doppler Assessment of Hepatic Venous Waves for Evaluation of Large Varices in Cirrhotic Patient.

This cross sectional study was conducted to evaluate the role of doppler ultrasonography of hepatic venous waves for evaluation of large varices in cirrhotic patients from July 2013 to June 2015 in Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Patients getting admitted in the ward with a diagnosis of cirrhosis were enrolled in the study and purposive sampling technique was adopted. The sample size was 43. Data were collected by face to face interview and some data were gathered by records review and analyzed with the help of SPSS windows version - 12 software programs. Statistical significance was set at P<0.05 and confidence interval set at 95%. The research protocol was approved by the local ethical committee. Esophagogastroduodenoscopy is the gold standard for the diagnosis of esophageal varices. If the gold standard is not available, other possible diagnostic steps would be Doppler ultrasonography of the blood circulation (not endoscopic ultrasonography). Although and it can certainly demonstrate the presence of varices. In 60.47% of patient's monophasic wave pattern was seen and in 39.53% of cases biphasic & triphasic wave pattern were detected. Endoscopic examination was performed in all selected patients. In this study, 67.44% is large varices, 32.66% is small varices. Chi Square test was done for hypothesis testing and it was found significant (<0.05) and it indicates monophasic wave in Doppler USG signifies large varices. This test was also done to find out whether any significant difference of hepatic venous waveform in between male and female but it was not significant (>0.05). Diagnostic performance of USG for evaluation of varices showed, Sensitivity: 86.2%, Specificity: 92.85%, PPV: 96%, NPV: 76.47%, Accuracy 88%. Correlation co-efficient was 0.0064 which indicates moderately positive correlation in between monophasic hepatic venous waveform pattern by Doppler USG and large varices in oesophagogastroduodenoscopic findings Normal hepatic wave form shows triphasic pattern. Loss of this pattern in cirrhosis is mainly due to loss of compliance of liver. In conclusion, the loss of triphasic pattern of hepatic wave form is highly sensitive in predicting the presence of large varices in cirrhotic patients and this doppler parameter may be used as a non-invasive test for cirrhotic patients, who wish to avoid upper GI endoscopy. Further studies using a combination of various doppler parameters are needed to create indices with a better predictive value.

Giant Retroperitoneal Fibrolipoma - A Case Report.

Lipomas are common benign adipose tumours generally located at superficial locations but deep seated lipomas are rather infrequent out of which retroperitoneal location of giant lipoma is rare. Fibrolipoma is one of the uncommon variant of lipoma. There is no different evidence in clinical profile, management, and prognosis of fibro lipoma from other variants of lipomas. Complete surgical excision is the treatment of choice. Here we present a case of 13 year old lady with giant retroperitoneal fibrolipoma which was completely excised through laparotomy. And the patient remains well one year after surgery without recurrence of the disease.

Efficacy and safety of low-dose otelixizumab anti-CD3 monoclonal antibody in preserving C-peptide secretion in adolescent type 1 diabetes: DEFEND-2, a randomized, placebo-controlled, double-blind, multi-centre study.

AIMS: Phase III DEFEND-2 investigated whether otelixizumab (3.1 mg over 8 days) preserved C-peptide secretion in patients with new-onset Type 1 diabetes, focusing on adolescents (12-17 years). METHODS: One hundred and seventy-nine patients (54 adolescents) were randomized to otelixizumab or placebo. The primary endpoint was change in 2-h mixed-meal-stimulated C-peptide area under the curve at month 12. Enrolment was suspended in April 2011 following negative efficacy results from DEFEND-1. DEFEND-2 terminated early after 12 months' efficacy and safety follow-up. RESULTS: Change from baseline C-peptide was not significantly different [∆ = -0.09 nmol/l (95% CI -0.17 to 0; P = 0.051)]. No differential C-peptide effect was seen for otelixizumab in adolescents and more adverse events were reported. CONCLUSIONS: Efficacy and tolerability of otelixizumab was similar to DEFEND-1. The 3.1-mg dose was non-efficacious in adults and adolescents. Further investigation of the mechanism of action seen at higher doses and therapeutic window is required. Clinical Trials Registry No: NCT 00763451.

Evaluation of adjuvant role of topical cyclosporine 1% in acute Stevens-Johnson syndrome: a randomised control trial.

PURPOSE: To evaluate the role of topical cyclosporine A 1% (CsA) as an adjuvant therapy in patients with acute Stevens-Johnson syndrome (SJS). METHODS: This is a randomised controlled trial in which 44 patients (88 eyes) with acute SJS, presenting within 3 months from the onset of the disease, were enrolled and randomised. Group A (n=44 eyes) patients received treatment with topical CsA 1% along with standard therapy consisting of topical corticosteroids, antibiotics and lubricants. Group B (n=44 eyes) patients received topical saline drops in combination with standard therapy. Various ocular surface parameters were assessed at baseline and the 6-month follow-up. RESULTS: The mean age of patients (years) was 23.9±15.1 in the CsA group and 26.0±18.7 in the control group (p=0.6840). The mean time from disease onset to presentation (days) was 17.0±14.0 and 12.9±11.3 in CsA and control groups, respectively (p=0.1568). At presentation, the mean grades of severity scores of various parameters were comparable. At 6 months, both groups showed a significant improvement in the mean severity grades of conjunctival hyperaemia (A, p=0.001; B, p=0.0001), mucocutaneous junction involvement (A, p=0.001; B, p=0.0001) and meibomian gland involvement (A, p=0.0471; B, p=0.006). Compared with baseline, the grades of corneal keratinisation (baseline, 0.48±0.7; 6 months, 1.02±0.8; p=0.0015) and neovascularisation (baseline, 1.07±1.2; 6 months, 1.57±1.0; p=0.0412) worsened after 6 months of CsA therapy. Intergroup comparison of grades of various parameters however did not reveal any significant difference at 6 months. CONCLUSIONS: Adjuvant treatment with topical CsA is not superior to standard therapy, in cases of acute SJS.

A 10 year old boy with rectal carcinoma.

A 10 year old boy with mucinous carcinoma of rectum is a rare case at this age. Here the patient presented with constipation, mucus in stool & abdominal pain since one month. He got consultation from several physicians & went through sonology of whole abdomen several times. There he was missed diagnosed as a case of pyloric stenosis. We came to a probable diagnosis by doing simple digital rectal examination which seemed to be a hard rectal swelling. The diagnosis was established by colonoscopy followed by biopsy. Carcinoma rectum must be considered as a differential diagnosis if patient presents with altered bowel habit, per rectal bleeding, abdominal pain in conjunction with weight loss.

Removal of benzene from wastewater via Fenton pre-treatment followed by enzyme catalyzed polymerization.

This study investigated the feasibility of a two-step process for the removal of benzene from buffered synthetic wastewater. Benzene is outside the scope of enzymatic removal. In order to remove it from wastewater using enzyme, its pretreatment by modified Fenton reaction was employed to generate the corresponding phenolic compounds. In the first phase, the optimum pH, H2O2 and Fe2+ concentrations and reaction time for the Fenton reaction were determined to maximize the conversion of benzene to phenolic compounds without causing significant mineralization. The pretreatment process was followed by oxidative polymerization of the phenolic compounds catalyzed by a laccase from Trametes villosa. Factors of interest for the three-hour enzymatic treatment were pH and laccase concentration. Under optimum Fenton reaction conditions, 80% conversion of the initial benzene concentration was achieved, giving a mixture containing oxidative dimerization product (biphenyl) and hydroxylation products (phenol, catechol, resorcinol, benzoquinone and hydroquinone). Enzymatic removal of biphenyl and benzoquinone was not possible but 2.5 U/mL laccase was successful in removal of the rest of the phenolic

Pharmacokinetics-Based Optimization of Phototherapy in Neonates Undergoing Treatment for Hyperbilirubinemia.

Introduction: Neonatal jaundice results from combined effects of both increased production of bilirubin and decreased hepatic excretory capacity in neonates. Since its discovery, phototherapy is the most widespread treatment used in neonatal jaundice. In this work, we try to search for a relationship between exposure to phototherapy and decrease in serum bilirubin (linearity vs proportionality). Methods:The present research was non-randomized prospective study conducted in the Neonatal Intensive Care Unit (NICU), Department of Paediatrics, AIIMS, New Delhi, and the Department of Pharmacology, AIIMS, New Delhi, India. Subjects were recruited from neonates admitted in NICU AIIMS, which meets our selection criteria. Infants were given a low dose of either phototherapy continuously or phototherapy for the first six hours and a double dose of phototherapy for the next six hours. Samples were collected before the beginning of the study (0 hours) and then at six and 12 hours. Bilirubin concentration was measured using HPLC and (LC-MS/MS). Results and conclusion:The percentage of reduction during the 6-12-hour interval was compared with that during the 0-6-hour interval if all experimental conditions were kept unchanged. A relationship curve between percentage of reduction and irradiance was created based on the percentage of reduction in serum bilirubin during the 0-6-hour and 0-12-hour intervals. The present study suggests that the relationship between efficacy, as measured by percentage of reduction in serum bilirubin, and irradiance is unlikely to be linear. Collected data are insufficient to clearly distinguish between proportionality and saturation point, considering that the results may be possible with both of these hypotheses.

Soybean peroxidase-catalyzed removal of an aromatic thiol, 2-mercaptobenzothiazole, from water.

This paper demonstrates, for the first time, the capability of soybean peroxidase (SBP), an enzyme, for catalyzing the removal of an aromatic thiol, 2-mercaptobenzothiazole (MBT), from aqueous solution. The optimum pH for enzymatic conversion of MBT in aqueous buffer was found to be in the range 6.0 to 9.0. The optimum hydrogen peroxide (H2O2): MBT stoichiometry was 0.6. In terms of standard units (U) of catalytic activity, the minimum SBP concentration required for 95% conversion of 1.0 mM MBT in 3 hours was found to be 0.9 U/mL. The presence of polyethylene glycol at 50 mg/L can reduce the enzyme concentration required for the same conversion by 3-fold. It is proposed that these findings should be the basis for viable and cost-effective treatment of MBT in industrial wastewater and/or process water.

Factors Related to Noninvasive Ventilation Outcomes during an Episode of Hypercapnic Respiratory failure in Chronic Obstructive Pulmonary Disease.

Non invasive ventilation (NIV) plays a vital role in the treatment of an episode of Hypercapnic respiratory failure (HRF) in Chronic obstructive pulmonary disease (COPD) patients. We wanted to investigate the possible effect on NIV outcomes of i) demographic factors, ii) the etiology of an episode of HRF and iii) the overall number and "individual" chronic and acute co-morbidities iv) biochemical parameters in COPD patients ventilated for an episode of HRF. This prospective study of 102(49.29%) COPD patients with HRF were eligible for NIV conducted in Respiratory care unit (RCU) and Intensive care unit (ICU) of National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka, Bangladesh from July 2016 to December 2017. Among them 70(68.63%) patients were improved and 32(31.37%) were not improved. On the study, some variables were associated with NIV outcome. On gross difference, two sample Z test had been applied in variables - age (p<0.01), mean days hospital stays before introduction of NIV (p<0.0001), APACHE II (Acute Physiological And Chronic Health Evaluation II) (p<0.001), Charlson co-morbidity index (CCI) (p=0.0212), serum albumin (p<0.001), PH (p=0.007), serum potassium (p<0.0001) whereas χ² test had been applied in variables - nutritional status (p<0.01), pneumonia (p=0.0003), dementia (p=0.0004), connective tissue disease (p=0.0094), mild liver disease (p=0.0355), diabetes mellitus with end organ damage (p=0.017), renal disease (p=0.0462), fibrothorax (p=0.0422). Some variables were not associated (p>0.05) with NIV outcome- two sample Z test had been done in variables- smoking status, PaO2 /FiO2 (p=0.7235), HCO3 - (p=0.1552), serum sodium (p=0.0827) whereas χ² test had been done in variables - sex, educational background, congestive heart failure (p=0.06), cardiogenic pulmonary oedema (p=0.6358) and pneumothorax (p=0.06), history of myocardial infarction (p=0.1024), congestive heart failure (p=0.06), peripheral vascular disease (p=0.4636), cerebrovascular disease (p=0.1074), peptic ulcer disease (p=0.06), hemiplegia (p=0.4138) , Diabetes without end organ damage (p=0.1034), tumour without metastasis (p=0.42259), solid tumour with metastasis (p=0.0562), leukaemia (0.1388), lymphoma (p=0.9388), obstructive sleep apnoea (0.9395), bed ridden patients (0.4984), history of pulmonary tuberculosis (p=0.08), kyphoscoliosis (p=0.1388), pneumenectomy (p=0.1388). On logistic regression analysis, eight variables had been shown association with NIV outcome among the seventeen variables which had association with NIV outcome in two sample Z test and χ² tests. Presence of Dementia increased chance of NIV failure 19.32 times, diabetes with end organ damage 10.9375 times and pneumonia 5.3636 times, fibrothorax 3.8077 times, renal disease 2.7273 times. Serum potassium imbalance 1.4615 times and increased serum albumin 1g/dl increased chance of NIV success 1.79 times, PH had also association with NIV outcome. Variables that predict the outcome of NIV are some non modifiable and some modifiable. If special precaution is taken for non modifiable variables and necessary management to correct the abnormalities of modifiable variables, improvements of patient's condition with NIV will be more satisfactory than the present condition.

Relation of Hepatic Venous Doppler Sonography and Portal Flowmetry in Determination of Severity of Esophageal Varices in Liver Cirrhosis.

Cirrhotic patients have hepatic vein waveform abnormalities (HVWA). Both Doppler ultrasonography of hepatic venous wave form (HVWF) and portal Doppler flowmetry (PDF) can non invasively recognize hepatic vein wave form abnormalities and determine severity of esophageal varices. Here we applied cross sectional study and found out the relation between HVWF and PDF and duration of the study from July 2016 to June 2017 in a tertiary Medical College Hospital, Bangladesh. 49 purposively taken diagnosed, hospital admitted, cirrhotic patients were included. Face to face interview and reviewing of records were the source of data and it was analyzed by SPSS windows version-12 software programs. At first, local ethical committee approved the study protocol, p<0.05 was statistically significant and 95% was confidence interval. Esophagogastroduodenoscopy is the gold standard for the diagnosis of esophageal varices. Alternative diagnostic investigations would be either HVWF or PDF. HVWF were normal triphasic. Abnormal biphasic and monophasic PDF consisted of the maximum values of portal flow velocity, portal vein flow volume, diameter of the portal vein, and congestion index. Small and large varices were the easiest form of endoscopic grading of esophageal varices. No clinical or echocardiographic feature of right sided heart failure had found in any patient. Both HVWF and PDF can certainly demonstrate the presence of varices but only HVWF detected severity of esophageal varices - monophasic wave (60.47%) in Doppler USG which signified (<0.05) large varices (67.44%) in endoscopy and in biphasic wave (31.53%) in Doppler USG which signified small varices (32.66%) in endoscopy. Patients who developed varices had portal vein diameter (PVD) and congestion index (CI) were higher (p<0.02) and portal vein velocity (PVV) was lower (p<0.05) than whom did not develop varices, but severity of varices could not be detected. Portal vein flow volume (PVFV) did not signify the presence or severity of varices. Moderately positive correlation (correlation co-efficient was 0.0064) was found between Doppler USG of HVWF and esophagogastroduodenoscopic in severity detection varices. In determination of severity of esophageal varices in patients with liver cirrhosis Hepatic venous Doppler sonography plays more vital role than PDF.

Association of Ultrasound in Evaluation of Impalpable Supraclavicular Lymph Nodes in Patients with Suspected Lung Cancer.

Lung cancer is the leading cause of death from cancer in the world as well in Bangladesh. Diagnosis is usually confirmed by invasive procedures such as bronchoscopy, mediastinoscopy, or image guided biopsy. In this prospective study suspected lung cancer patients with N2 or N3 disease on CT scan had gone through ultrasound guided FNAC from impalpable, enlarged supraclavicular lymph nodes. If positive, this technique helps to both stage the patient and provide a confirmed diagnosis. Ninety one (91) patients were enrolled prospectively over a 1 year period in National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka, Bangladesh from 1 July 2016 to 30 June 2017. Fifty one (51) of 91 patients who have more than 5mm in size supraclavicular lymph nodes were studied. The overall malignant yield was 39.56% of patients scanned and 70.58% of patients sampled. As a result of FNAC, 37 patients (40.66%) avoided more invasive procedures. For diagnosis and staging of lung cancer, Ultrasound guided FNAC is a new modality and comparatively non invasive procedure.

Laccase-catalyzed removal of 2,4-dimethylphenol from synthetic wastewater: effect of polyethylene glycol and dissolved oxygen.

The potential use of laccase (SP-504) in an advanced oxidation-based treatment technology to remove 2,4-dimethylphenol (DMP) from water was investigated with and without the additive, polyethylene glycol (PEG). The DMP concentration was varied between 1.0 and 5.0 mM. The optimization of pH and enzyme concentration in the presence and absence of PEG was carried out. All experiments were carried out in continuously stirred reactors for 3h at room temperature. The reaction was initiated by adding enzyme to the reaction mixture. For more than 95% removal of DMP, the presence of PEG reduced the inactivation of enzyme so that the required enzyme concentrations were reduced by about 2-fold compared to the same reactions in the absence of PEG. Finally, the PEG concentrations were optimized to obtain the minimum dose required. For higher substrate concentrations, the availability of oxygen was insufficient in achieving 95% or more removal. Therefore, the effect of increasing dissolved oxygen at higher substrate concentration was investigated. The laccase studied was capable of efficiently removing DMP at very low enzyme concentrations and hence shows great potential for cost-effective industrial applications.

Laccase-catalyzed removal of diphenylamine from synthetic wastewater.

The priority pollutant lists of both the U.S. Environmental Protection Agency (U.S. EPA) and the European Union (EU) include diphenylamine (DPA), a contaminant found in wastewater of various industries. This work demonstrates the potential of using enzymatic treatment to remove DPA from buffered synthetic wastewater. This treatment method includes oxidative polymerization of DPA using laccase from Trametes villosa, followed by removal of those polymers via adsorptive micellar flocculation (AMF) using sodium lauryl sulfate (SDS) and alum. Researchers investigated the effects of pH, laccase concentration, molecular mass, and concentration of polyethylene glycol (PEG) in continuously stirred batch reactors to achieve 95% substrate conversion in three hours. Treatment of 0.19 mM DPA was best at pH 7 and an enzyme concentration from 0.0025 to 0.0075 standard activity unit/mL. Except for PEG400 optimum enzyme and PEG concentrations decreased with an increase in PEG molecular mass. Optimum AMF conditions were pH 3.0 to 6.5, 200 mg/L of SDS, and 150 mg/L of alum.

Beneficial reuse of precast concrete industry sludge to produce alkaline stabilized biosolids.

The precast concrete industry generates waste called concrete sludge during routine mixer tank washing. It is highly alkaline and hazardous, and typically disposed of by landfilling. This study examined the stabilization of municipal sewage sludge using concrete sludge as an alkaline agent. Sewage sludge was amended with 10 to 40% of concrete sludge by wet weight, and 10 and 20% of lime by dry weight of the sludge mix. Mixes containing 30 and 40% of concrete sludge with 20% lime fulfilled the primary requirements of Category 1 and 2 (Canada) biosolids of maintaining a pH of 12 for at least 72 hours. The heavy metals were below Category 1 regulatory limits. The 40% concrete sludge mix was incubated at 52 degrees C for 12 of the 72 hours to achieve the Category 1 and 2 regulations of less than 1000 fecal coliform/g solids. The nutrient content of the biosolids was 8.2, 10 and 0.6 g/kg of nitrogen, phosphorus and potassium respectively. It can be used as a top soil or augmented with potassium for use as fertilizer. The study demonstrates that concrete sludge waste can be beneficially reused to produce biosolids, providing a long-term sustainable waste management solution for the concrete industry.

Evaluation of Knowledge Regarding Oral Anti-diabetic Agents among Hospitalized Diabetic Patients.

Knowledge regarding oral anti-diabetic agents help to enhance compliance among diabetic patients. Though it is an important aspect of management, data evaluating it is scarce in our country. This cross sectional observational study carried out in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from September 2013 to February 2014 and was undertaken to determine basic knowledge about oral anti-diabetic agents among hospitalized diabetic patients taking or took oral anti-diabetic agents. In this study main outcome measures were socio-demographic characteristics, knowledge regarding oral anti-diabetic agents, frequency of previous hospital admission, regularity in taking oral anti-diabetic agents, causes of irregularity in taking medicine and knowledge related to hypoglycemia. Mean±SD age was 55±7.14 years, of the patients who were included in this study. Only 33% of patients knew side effects of oral anti-diabetic agents, 34% didn't know that drug should not be stopped before giving blood for glucose estimation, in answering to 9 basic question related to oral anti-diabetic agents 56% obtained score within 0-5, overall mean 5.2±1.47. Among them 38% used to take drug irregularly. Correlation with knowledge score and regularity in taking drug showed significant relation (p<0.01). This study has demonstrated unsatisfactory knowledge on oral anti-diabetic agents among type 2 diabetic patients and significant relation with knowledge on oral anti-diabetic agents and patients compliance. An improvement with this respect may be achieved through continuing patients education about diabetes and its treatment.