Socio-economic inequalities in undiagnosed, untreated, and uncontrolled diabetes mellitus in Bangladesh: is there a gender difference?

OBJECTIVES: We aimed to determine: (1) the prevalence and socio-economic distribution of undiagnosed, untreated, and uncontrolled diabetes mellitus (DM); (2) the relationship between socio-economic status (SES) and undiagnosed, untreated, and uncontrolled DM; and (3) if this relationship is mediated by gender. STUDY DESIGN: Cross-sectional nationally representative household-based survey. METHODS: We used data from the Bangladesh Demographic Health Survey from 2017 to 18. Our findings were based on the responses of 12,144 individuals aged 18 years and older. As a measure of SES, we focused on standard of living (hereinafter referred to as wealth). The study's outcome variables were prevalence of total (diagnosed + undiagnosed), undiagnosed, untreated, and uncontrolled DM. We used three regression-based approaches-adjusted odds ratio, relative inequality index, and slope inequality index-to assess different aspects of SES differences in the prevalence of total, undiagnosed, untreated, and uncontrolled DM. We used logistic regression analysis to look at the adjusted association between SES and the outcomes after gender stratification to see whether gender status moderates the association between SES and the targeted outcomes. RESULTS: In our sample analysis, the age-adjusted prevalence of total, undiagnosed, untreated, and uncontrolled DM was 9.1%, 61.4%, 64.7%, and 72.1%, respectively. Females had a higher prevalence of DM and undiagnosed, untreated, and uncontrolled DM than males. When compared to people in the poor SES group, people in the rich and middle SES groups had 2.60 times (95% confidence interval [CI] 2.05-3.29) and 1.47 times (95% CI 1.18-1.83) higher chance of developing DM. When compared to individuals in the poor SES group, those in the rich SES groups were 0.50 (95% CI 0.33-0.77) and 0.55 times (95% CI 0.36-0.85) less likely to have undiagnosed and untreated DM. CONCLUSIONS: In Bangladesh, rich SES groups were more likely than poor SES groups to have DM, whereas poor SES groups with DM were less likely than rich SES groups to be aware of their disease and obtain treatment. The government and other concerned parties are urged by this study to pay more attention to developing suitable policy measures to reduce the risk of DM, particularly among rich SES groups, as well as targeted efforts to screen for and diagnose DM in socio-economically disadvantaged groups.

Cytopathic effect of Vero cells adapted Bangladeshi strain of peste des petits ruminants (PPR) virus in cell culture.

The present study described the cytopathic effect of PPR virus presently being used in serial passages at the level of 60th in Vero cells and infected tissue culture fluid was used in this study as viral inoculum. Vero cells were grown on cover slip & were infected with tissue culture fluid at a fixed multiplicity of infection (MOI) 0.01. The infected cover slip along with control were stained with H&E stain at periodic intervals and cytopathic effect was studied with microscope. The cytopathic effect (CPE) was visible at first from 24 hpi and the Vero cells showed initial cell rounding, aggregation, and syncytial development. Development of inclusion bodies and cell degradation was noticed by 72 hpi. Complete detachment of the cell monolayer was observed by 84 hpi. It is concluded that, development of numerous inclusion bodies are the indication of well adaptation & extensive multiplication of PPRV in Vero cells.

Parameters controlling the strength of stochastic fibrous materials.

Many materials of everyday use are fibrous and their strength is important in most applications. In this work we study the dependence of the strength of random fiber networks on structural parameters such as the network density, cross-link density, fiber tortuosity, and the strength of the inter-fiber cross-links. Athermal networks of cellular and fibrous type are considered. We conclude that the network strength scales linearly with the cross-link number density and with the cross-link strength for a broad range of network parameters, and for both types of networks considered. Network strength is independent of fiber material properties and of fiber tortuosity. This information can be used to design fiber networks for specified strength and, generally, to understand the mechanical behavior of fibrous materials.

Poisson's Contraction and Fiber Kinematics in Tissue: Insight From Collagen Network Simulations.

Connective tissue mechanics is highly nonlinear, exhibits a strong Poisson's effect, and is associated with significant collagen fiber re-arrangement. Although the general features of the stress-strain behavior have been discussed extensively, the Poisson's effect received less attention. In general, the relationship between the microscopic fiber network mechanics and the macroscopic experimental observations remains poorly defined. The objective of the present work is to provide additional insight into this relationship. To this end, results from models of random collagen networks are compared with experimental data on reconstructed collagen gels, mouse skin dermis, and the human amnion. Attention is devoted to the mechanism leading to the large Poisson's effect observed in experiments. The results indicate that the incremental Poisson's contraction is directly related to preferential collagen orientation. The experimentally observed downturn of the incremental Poisson's ratio at larger strains is associated with the confining effect of fibers transverse to the loading direction and contributing little to load bearing. The rate of collagen orientation increases at small strains, reaches a maximum, and decreases at larger strains. The peak in this curve is associated with the transition of the network deformation from bending dominated, at small strains, to axially dominated, at larger strains. The effect of fiber tortuosity on network mechanics is also discussed, and a comparison of biaxial and uniaxial loading responses is performed.

The effect of temperate or tropical pasture grazing state and grain-based concentrate allocation on dairy cattle production and behavior.

Grain-based concentrate (GBC) supplement is of high cost to dairy farmers as a feed source as opposed to grazed pasture. Milk production response to GBC is affected by the composition and nutritive value of the remainder of the diet, animal factors, and interactions between forage type and level of GBC. In grazing systems, dairy cattle encounter contrasting pasture states, primarily because the social structure of the herd affects the timing of when each animal accesses a paddock after milking as a result of a relatively consistent cow milking order. However, the effect of feed management, namely pasture state and GBC allocation, on dairy cattle production and behavior is unknown. We examined the effect of varying GBC allocation for dairy cattle grazing differing states of kikuyu grass (Pennisetum clandestinum, a tropical pasture species; experiment 1) and annual ryegrass (Lolium multiflorum L., a temperate pasture species; experiment 2) on dry matter intake, milk production and composition, and grazing behavior. For each experiment, 90 lactating dairy cattle were randomly allocated to 2 consistent (fresh-fresh and depleted-depleted) and 2 inconsistent (fresh-depleted and depleted-fresh pasture state treatments (defined as sequences of pasture state allocation for the morning and afternoon grazing events) and 3 GBC treatments [2.7, 5.4, and 8.1 kg of dry matter (DM)/cow per day], giving 12 treatment combinations for each experiment. The duration of each experiment was 14 d, with the first 7 d used as adaptation to treatment. In each experiment, 3 cattle were selected from each of the 12 pasture type × GBC treatment groups within the experimental herd to determine herbage intake and total DM digestibility using the n-alkanes method (n = 36). There was no interaction between kikuyu grass or ryegrass pasture state and GBC level for intake, digestibility, or milk yield or components. Dairy cattle offered fresh-fresh and depleted-fresh ryegrass produced 9% more milk yield, in line with greater pasture intakes, compared with fresh-depleted and depleted-depleted pasture states. Dairy cattle offered fresh-fresh kikuyu grass had 8% more milk yield and 14% more milk protein yield than other pastures states, but there was no effect of pasture state on milk composition. Milk yield increased with GBC level for both pasture species (∼0.7-0.8 kg of milk/kg of DM GBC) as GBC level increased from 2.5 to 5.4 kg of DM/cow per day. There was a poor response (0.3 kg of milk/kg of DM GBC), and no response, when GBC levels increased from 5.4 to 8.1 kg of DM/cow per day for kikuyu grass and ryegrass, respectively, in line with pasture DMD. Time spent grazing, lying, and ruminating were not associated with kikuyu grass pasture state, GBC, or their interaction. Despite this, there was a linear increase in grazing time in the afternoon coinciding with a linear decrease in lying and rumination time for both kikuyu grass and ryegrass pasture. Together these findings reveal the effect of pasture state and GBC allocation on dairy cattle production and behavior. Tailoring GBC allocation to the state of pasture accessed by cattle appears unwarranted, but there is an opportunity to alter the timing of pasture access to increase herd-level milk production efficiency.

Towards Attosecond High-Energy Electron Bunches: Controlling Self-Injection in Laser-Wakefield Accelerators Through Plasma-Density Modulation.

Self-injection in a laser-plasma wakefield accelerator is usually achieved by increasing the laser intensity until the threshold for injection is exceeded. Alternatively, the velocity of the bubble accelerating structure can be controlled using plasma density ramps, reducing the electron velocity required for injection. We present a model describing self-injection in the short-bunch regime for arbitrary changes in the plasma density. We derive the threshold condition for injection due to a plasma density gradient, which is confirmed using particle-in-cell simulations that demonstrate injection of subfemtosecond bunches. It is shown that the bunch charge, bunch length, and separation of bunches in a bunch train can be controlled by tailoring the plasma density profile.

Short communication: The diurnal intake and behavior of dairy cows when access to a feed of consistent nutritive value is restricted.

The diurnal variation in pasture nutritive value adds a confounding factor to studies elucidating the effect of time of day on behavior. Our work separates the effect of time of day on both feeding and lying patterns for cows outdoors to enable the alignment of feeding behavior with feed management. We determined the diurnal intake patterns and behavior of dairy cows when the nutritive value of feed remained constant throughout 24 h in an outdoor environment, and when feed access was restricted. Nine nonlactating Holstein-Friesian cows (live weight 626 ± 53 kg, age 96 ± 33 mo; mean ± SD) were split into 3 groups of 3 and offered lucerne hay cubes (cube volume 32 mm3) ad libitum according to 3 treatments: full access (FA, feed access 24 h), day access (DA, feed access between 0600 and 1800 h), and night access (NA, feed access between 1800 and 0600 h). Treatments were applied to individual cows in a crossover design with 7-d periods. During the last 4 d of each period, data were collected on feed intake, as well as feeding and lying behaviors. Total daily intake was greater for cows on the FA treatment (3.5% of BW) compared with the DA and NA treatments at 3.1 and 2.9% of BW, respectively. The cows with FA consumed 69% of their total intake during the day (0600-1800 h), with the greatest intake (39%) occurring during 1200 to 1800 h and only 12% of intake occurring during 2400 to 0600 h. Cows with DA consumed 56% of feed during 0600 to 1200 h and 44% during 1200 to 1800 h. In contrast, NA cows consumed more feed (74%) during the first 6 h period (1800-2400 h), thus maximizing lying time between 2400 and 0600 h. The time spent lying throughout daylight periods varied between treatments; however, total daily lying time was similar across the 3 treatments. This experiment shows the feeding and lying behaviors of cows when feed quality remains constant throughout 24 h, which will assist the formulation of variable feed allocation strategies for future testing in both robotic and conventional milking systems. Varying the quantity of feed offered throughout 24 h may benefit robot utilization at night in automatic milking systems through increased feeding activity, and as we observed, is likely to have little effect on lying time or DMI, with cows readily adapting to changes in feed management. Conversely, aligning feed on offer with preferred feeding time in conventional milking systems may increase the intake of high quality pasture.

Angiomyofibroblastoma of Vulva in a Very Young Adult Female: A Rare Case Report.

Angiomyofibroblastoma is a rare, well circumscribed benign mesenchymal neoplasm, usually arising in the pelviperineal region, especially the vulva and apparently composed of stromal cells distinctive to this anatomic region. Preoperative diagnosis of Angiomyofibroblastoma is very difficult, mostly diagnosed as Barthloin cyst due to its anatomical location. It is a histological diagnosis. In this article we report a case of Angiomyofibroblastoma of vulva.

Primary and Revision Lumbar Discectomy: A Four-Year Review from Our Private Practice.

The surgical treatment of symptomatic lumbar disc herniation is now focused on nerve root decompression with preservation of the bony and ligamentous stabilizers of the spine. Various techniques of discectomy have been devised in accordance with this principle and irrespective of the technique used; primary disc surgeries have generally known to give good results. This retrospective study was done in different private clinics & hospitals of Dhaka city, Bangladesh from January 2012 to December 2015. Of the 105 lumbar discectomies performed during the study period, 95(90.4%) patients fulfilled the inclusion criteria and were included in the analysis. Of these, 90 patients had primary discectomy, while the remaining 5 were revision surgeries. The follow-up varied from 1-4 years, but the clinical outcomes were evaluated at the end of one year from surgery in all the patients. In the primary surgery group there were 50(55.56%) men and 40(44.44%) women, while the revision group had 01(20%) men and 04(80%) women. The age distribution was similar in both the groups, with the maximum numbers (44% and 42.9%) in the fourth decade of life. Of the 05 patients who underwent revision surgery, 03 belonged to the primary surgery group of this study, while the remaining 02 had undergone their primary surgery elsewhere. Excluding the two residual discs, the remaining 03 patients with recurrences gave a history of complete resolution of symptoms after the primary surgery. Amongst these, 3(60%) had a history of a precipitating event prior to onset of pain, 2 had a definitive history of significant lack of physical activity. The time interval between the primary and revision surgery ranged from three months to 10 years (average 2.6 years).

Use of Acute Physiology and Chronic Health Evaluation (APACHE)-II and Red Cell Distribution Width (RDW) for Assessment of Mortality of Patients with Sepsis in ICU.

Critically ill patients of Intensive Care Unit (ICU) need highest level of monitoring, intense nursing care and integrated management which are very expensive and consume significant part of hospital resources. Prediction of outcome from disease has become an essential component of health science. So, various scoring systems have been developed to predict outcome of critically ill patients in ICU. There is no perfect model of severity score to predict ICU mortality. Search for new system is still remaining as continuous efforts to find the best model to get accurate information about the prognosis and outcome of critically ill patients. This observational prospective cohort study was carried out in ICU of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2015 to September 2015 to evaluate the ability of mortality prediction of Acute Physiology and Chronic Health Evaluation (APACHE)-II after adding RDW. Total 62 patients, clinically diagnosed as sepsis with positive culture were included in this study after analyzing selection criteria. APACHE II score model was compared with APACHE II plus RDW score model in relation to mortality outcome assessment. Sensitivity, Specificity, Positive predictive value (PPV), Negative predictive value (NPV) and Receiver Operating Characteristic (ROC) curve were used as parameter to compare the predictive ability of the two models. The derived model APACHE II- RDW was found with higher predictive power (Pearson's correlation coefficient - 0.915) than APACHE II (Pearson's correlation coefficient - 0.885) in relation to mortality (p<0.01). Accuracy was compared by using Receiver Operating Characteristic (ROC) curve between the two models and AUROC was found higher (AUC-0.87) in case of new model compared with conventional model (AUC-0.85). So combination of RDW with APACHE-II increases the predictive ability of the scoring model in relation to mortality.

Correlation of the Serum Level of Carcinoembryonic Antigen and Prolactin with Different Stages of Colorectal Carcinoma According to Dukes' Staging.

Carcinoembryonic antigen (CEA) is well established tumor marker for colorectal cancers worldwide. Recent studies show that serum prolactin level is also raised in colorectal cancers. The purpose of the study is to evaluate the correlation of serum CEA and Prolactin with Dukes' staging of colorectal carcinomas. Between January 2013 and June 2013, Serum CEA and Serum Prolactin were measured by radioimmunoassay from 103 patients who were histopathologically diagnosed as colorectal carcinomas. Evaluation of the stages of the colorectal cancers was done on the basis of preoperative investigations and postoperative histopathology and correlated with Preoperative Serum CEA and Serum Prolactin. Results were presented as median value, range and percentage. Male to female ratio was 1.4:1 with median age of 42.26 years (range 17-78 years). Most of the patients in this series presented with carcinoma rectum (42%). Most of the patients (52%) were found in Dukes' stage C and 27% and 15% cases were found as Dukes' stage B and Dukes' stage D respectively. Stage of the disease is directly proportionate to percentage of the patient with high serum prolactin except early stage (Dukes' A-50%, Dukes' B-28.6%, Dukes' C-33.3% & Dukes' D-46.7%). Similarly serum CEA level is directly proportionate to tumor stage (Dukes' A-0%, Dukes' B-32%, Dukes' C-40.7% & Dukes' D-74.7%). A preoperative high serum CEA value suggests advanced disease either locally or with distant metastasis. In contrast preoperative high serum prolactin (hyperprolactinaemia) did not suggest advanced disease as it can be elevated even in early stage of disease. Serum CEA and Serum Prolactin both are valuable tumor markers but serum CEA could not be replaced by serum Prolactin. Serum Prolactin may be a helpful marker in earlier stages of the colorectal cancer.

Associations and Risk Factors of Diabetic Maculopathy.

Diabetic maculopathy is characterised by increased capillary leakage in the main retinal vessels and by alterations in the microcirculation of the macula. Maculopathy occurs frequently in type 1 and type 2 diabetic patients. Prevalence is higher in type 2 than in type 1 diabetic patients. Factors associated with the development of maculopathy are mostly unknown. As maculopathy is the main cause of vision deprivation in diabetic patients it is essential to know the associations and risk factors of diabetic maculopathy so that appropriate measures can be taken to prevent as well as treat diabetic maculopathy. We started the research work to find out the relation between diabetic maculopathy and various associated factors and risk factors for patients with diabetic retinopathy with maculopathy. This cross-sectional observational study done at the Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka & National Institute of Ophthalmology & Hospital (NIO & H), Sher-e-Bangla Nagar, Dhaka, Bangladesh from January 2006 to June 2006. In this study out of 50 patients, diabetes was controlled in 20(40%) patients and uncontrolled in 30(60%). A significant percentage of patients (40%) had elevated blood pressure. Diabetic autonomic neuropathy was observed in 24% cases and polyneuropathy was observed in 36% cases. It is evident that diabetic maculopathy has association with dyslipidaemia, abnormal renal function due to nephropathy. This study lighted on the association of diabetic maculopathy with diabetic nephropathy, cardiac abnormalities and diabetic neuropathy.

Comparison between Decompressive Craniectomy with Durotomy and Conservative Treatment in Spontaneous Supratentorial Intracerebral Hemorrhage.

Large Intracerebral hematoma (ICH), compounded by perihematomal edema can produce severe elevations of intracranial pressure (ICP). Decompressive craniectomy (DC) beneficially addresses mass effect. Therefore this study is aimed to prove that decompressive craniectomy with durotomy has better outcome in patients with spontaneous supratentorial ICH than conservatively treated patients. This Quasi-Experimental study was carried out in the Department of Neurosurgery, Dhaka Medical College & Hospital (DMCH), Dhaka, Bangladesh from July 2012 to December 2013 using purposive sampling procedure. A total of 80 admitted adult hypertensive patients with spontaneous supratentorial ICH were enrolled in the study population fulfilling all selection criteria. Of them 40 patients underwent decompressive craniectomy with durotomy was considered as surgical group and 40 patients were treated conservatively was considered as conservative group. All the cases were continuously followed up and GCS score at 7(th) day of treatment (D7) and at discharge was recorded. Mean±SD hematoma volume was 56.91±13.72ml in surgical patients and in conservative group 51.80±13.58ml. Outcome measured by modified Rankin Scale at 3 months. Sixty percent (60%) patients had good outcome (mRS 0-4) and 40% patients had poor outcome (mRS 5-6) in surgical group. On the other hand, 52.5% patients had good (mRS 0-4) and 47.5% had poor (mRS 5-6) outcome in conservative group. In logistic regression analysis, conservative group was 3.643 times more prone to develop poor outcome than surgical group which was statistically significant (95% CI, 1.040-13.047; p value <0.05) and volume of hematoma [OR (95% CI), 1.131(1.059-1.207); p value <0.001)] was the most important predictor of outcome. This study indicates that decompressive craniectomy with preservation of brain integrity in patients with spontaneous supratentorial ICH is feasible and safe. It can be a useful alternative surgical procedure in the treatment of spontaneous supratentorial ICH.

Huge Perineal Tumour: A Rare Presentation of Gastrointestinal Stromal Tumour of Rectum.

Gastrointestinal stromal tumour (GIST) is a relatively rare neoplasm of gastrointestinal tract of which Rectal GIST is uncommon. It produces symptoms of per rectal bleeding or change in bowel habit. Recurrences following curative resection are predominantly intraabdominal, hepatic metastasis occurring at a median 20-25 months following the primary surgery. A 42 years old male presented a huge mass in hypogastrium, the size of which was reduced ofter neoadjuvant therapy for period of 1.5 years. He underwent abdominoperineal resection. He developed recurrences in perineum three times and in thigh at short intervals after primary resection. He also developed liver metastasis. He died two and half years after primary diagnosis. Rectal GIST should be included in differential diagnosis of intraabdominal mass and preoperative diagnosis based on histopathological as well as the immunohistochemical feature of the CD(117) and CD(34). Although complete surgical resection with negative tumour margin is the principal curative procedure for primary and non metastatic tumours, further studies are still needed for the determination of the most effective treatment strategy for patients of rectal GIST.

Assessing the Rehabilitation of Achilles Tendon Ruptures using Modified Teuffer and Lindholm Technique.

The aim of this study is to assess the optimum rehabilitation and the functional outcome of open repaired Achilles tendon ruptures. This study was conducted for the 18 consecutive patients of complete ruptures at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from 2012 to 2013. Two groups were considered during 6 to 18 months post-operative observation and each group consist 9 patients. In the Group I, modified Teuffer's and in Group II, Lindholm operative methods were employed for the open repair of Achille tendon. The post operative outcomes were assessed for both of the groups through the modified Thermann's scores. In this study the patients median age was seen 39 years with 72.2% male and 27.8% female. The Thompson test was found positive in pre-operative and negative in post-operative outcome. The results shown that Achilles tendon ruptures occurred in 4 to 6cm rupture site, where the rupture side was 61.1% left and 38.9% right. The subjective overall assessment of total Thermann's scores were found very good (91 to 96) in 4 cases and (90 to 98) in 3 cases for Group I and Group II, respectively. Both of the operative techniques were found accountable results for rehabilitation. Therefore, based on the further statistical evidence of higher correlations and errors it may be concluded that Achilles tendon ruptures can be treated by modified Teuffer's or Lindholm technique.

The role of personality variables in predicting attitudes toward people with intellectual disability: An Australian perspective.

BACKGROUND: Personality dimensions such as openness and agreeableness have been found to be associated with prejudice levels towards several minority groups. Yet these variables have been mostly ignored by existing research into attitudes towards people with intellectual disability (PWID), which has primarily focused on contact and demographic variables. The current study investigated the relationship between personality dimensions and attitudes toward PWID. METHODS: An online survey was completed by 466 adult participants recruited through a variety of sources. The survey consisted of a well-validated attitude survey, the Big Five inventory, contact related and demographic questions. RESULTS: The hypothesis that higher levels of the personality dimensions openness and agreeableness would be significantly associated with positive attitudes towards PWID was supported. However the effect was relatively weak and the strongest predicting factor of positive attitudes was increased quality of contact with PWID. More positive attitudes were also associated with females, more highly educated and younger participants. CONCLUSIONS: Results provide support for an integrated (including person and situational factors) theoretical approach to attitudes research in this field. Practically, results support programmes that stimulate and promote quality interactions between PWID and the wider community.

Primary malignant melanoma of the penis with secondary to adrenal.

Primary malignant melanoma of penis with secondaries to the adrenal gland is rare. Here we report a case of malignant melanoma of penis in a 60 years old man who presented with intermittent gross, episodic haematuria of 11 months duration and a hard indurated pigmented fungating lesion over the glans penis. Following an initial tissue biopsy from the penile growth which revealed malignant melanoma the patient underwent partial Panectomy. Few days after recovery the patient underwent laparotomy and incisional biopsy from adrenal mass revealed metastatic malignant melanoma histopathologically.

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.

Comparative study of early and conventional catheter removal following buccal mucosal graft urethroplasty.

The duration of catheterization period following urethroplasty is a great controversy. For buccal mucosal graft urethroplasty recommended catheterization period ranges from 2-4 weeks. In recent years, early catheter removal has been advocated for several reasons. Early catheter removal improves both patient comfort, mobility and reduces catheter related complications and shortens post operative hospital stay. This prospective observational study was done from January 2007 and December 2008, 50 patients underwent dorsal onlay buccal mucosal graft urethroplasty for stricture urethra. Among them 25 cases were selected for early catheter removal on 7th postoperative day and 25 cases for conventional catheter removal at 3 weeks. Three patients (12%) of early catheter removal group and 2 patients (8%) of conventional catheter removal group exhibited periurethral leakage. One patient (4%) and three patients (12%) developed wound infection in early and conventional catheter removal group respectively. No significant difference was observed in urinary flow (p=0.089). In these two groups the mean postoperative hospital stay was significant (p<0.001). Early catheter removal on 7th postoperative day is safe and has better impact on patient comfort with minimum catheter related complications and shortens hospital stay.

Modelling Pasture-based Automatic Milking System Herds: Grazeable Forage Options.

One of the challenges to increase milk production in a large pasture-based herd with an automatic milking system (AMS) is to grow forages within a 1-km radius, as increases in walking distance increases milking interval and reduces yield. The main objective of this study was to explore sustainable forage option technologies that can supply high amount of grazeable forages for AMS herds using the Agricultural Production Systems Simulator (APSIM) model. Three different basic simulation scenarios (with irrigation) were carried out using forage crops (namely maize, soybean and sorghum) for the spring-summer period. Subsequent crops in the three scenarios were forage rape over-sown with ryegrass. Each individual simulation was run using actual climatic records for the period from 1900 to 2010. Simulated highest forage yields in maize, soybean and sorghum- (each followed by forage rape-ryegrass) based rotations were 28.2, 22.9, and 19.3 t dry matter/ha, respectively. The simulations suggested that the irrigation requirement could increase by up to 18%, 16%, and 17% respectively in those rotations in El-Niño years compared to neutral years. On the other hand, irrigation requirement could increase by up to 25%, 23%, and 32% in maize, soybean and sorghum based rotations in El-Nino years compared to La-Nina years. However, irrigation requirement could decrease by up to 8%, 7%, and 13% in maize, soybean and sorghum based rotations in La-Nina years compared to neutral years. The major implication of this study is that APSIM models have potentials in devising preferred forage options to maximise grazeable forage yield which may create the opportunity to grow more forage in small areas around the AMS which in turn will minimise walking distance and milking interval and thus increase milk production. Our analyses also suggest that simulation analysis may provide decision support during climatic uncertainty.