Association of Admission Glycemic Gap on Short-term Outcome of Neuro-critical Patients with Diabetes.

Both of neurological emergencies and hyperglycemia are independently associated risk factors of mortality in the ICU patients. In critically ills, hyperglycemia is secondary to already existing DM or stress-induced hyperglycemia (SIH). Admission glycemic gap (AGG) is considered as a reliable indicator of SIH. This study aimed to explore the association of AGG on diabetic neuro-critical patients' short-term mortality, and understand the potential of AGG as the predictor of outcome. Sixty adult diabetic neuro-critical patients admitted in ICU and stayed at least for 24 hours, were prospectively observed for 30 days, or until discharge or death, whichever came first. The patients' initial clinical assessment and HbA1c, CBC, ABG, and blood glucose level were done within 24 hours of admission. A1c derived admission glucose (ADAG) was calculated as, ADAG = (1.59 × HbA1c) - 2.59 (mmol/L). The AGG was calculated by subtracting ADAG from admission blood glucose level (ABGL). Death or survival of 30 days was our primary outcome and participants were divided between survivor or non-survivor groups according to primary outcome. Statistical comparisons of the study variables between the groups were performed and the relationship between parameters derived from blood glucose and mortality was prospected. Among the 60 patients enrolled, 35(58.3%) were non-survivors and 25(41.7%) were survivors. Age, sex, residence, primary diagnosis, co-morbidity, or drug history had no association with survival/non-survival. Among the initial clinical assessment parameters, lower GCS had significant association with non-survival. AGG, HbA1c, ADAG and ABGL were significantly different between the groups, with higher values in the non-survivors. Lower GCS, and higher AGG, HbA1c, ADAG and ABGL showed significant odds of non-survival. The highest odds of non- survival was for AGG (OR 2.95, 95% CI: 1.83-4.75; p<0.001). For ABGL and HbA1c the OR were 2.03 (95% CI: 1.44-2.86; p<0.001) and 1.93 (95% CI: 1.04-3.58; p<0.04) respectively. The final adjusted odds (aOR) of non-survival for higher AGG was 3.25 (95% CI: 1.71-6.16; p<0.001), signifying that AGG is independently associated with non-survival. AGG, GCS level, ABGL, HbA1c level, and ADAG can predict short-term outcome (mortality). However, AGG has the greatest potential to predict short-term outcome in diabetic neuro-critical patients.

Health Related Quality of Life in Patients with Pulmonary Tuberculosis.

Tuberculosis (TB) is one of the major public health issues in many developing nations especially in Bangladesh. Though most focus is being directed towards mortality and incidence rate, the changes in morbidity and other health status parameters are not been well considered. The aim of the study was a comprehensive assessment of patients with pulmonary tuberculosis by measuring patient's quality of life which may lead to better outcome in patients' health, infection surveillance and prevention programs. This prospective study was conducted in the department of Respiratory and Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2015 to March 2017. The quality of life scores of 61 smear positive pulmonary tuberculosis cases were measured by validated Bangla version of SF-36 questionnaire before or at the starting of treatment, after the initial phase and at the end of treatment. Then the score was compared with those of 75 healthy matched controls. The changes of the quality of life with the stage of treatment and with socio-demographic variables were assessed. Before treatment, all domains of HRQoL of the pulmonary TB patients were significantly lower than those of the control group (p<0.001). At the end of six-month treatment period, HRQoL of the pulmonary TB patient had significantly increased compared to before treatment (p<0.001). There was no significant difference of scores after six months of treatment with that of control (p>0.05). The lowest score in tuberculosis patients was related to general health perception and vitality. Patients with low socio economic status, low educational level, prolonged disease duration and increased number of symptoms had lower HRQoL scores.

Etiological Evaluation of Patients with Lymphadenopathy by Clinical, Histopathological and Microbiological Assessment.

Lymph node enlargement is a common presenting complaint in outpatient and inpatient department. The present observational cross sectional study was conducted in department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period from December 2014 to May 2016 to evaluate etiologies of significant lymphadenopathy by clinical, histopathological and microbiological assessment. Biopsy/FNA materials of 177 patients of 18-75 years age range with significant lymphadenopathy were sent for histopathology/cytology, Gram stain & culture, AFB stain & culture and Gene Xpert. Among them, 102(57.62%) were granulomatous lymphadenitis, 52(29.38%) were lymphoma, 12(6.78%) reactive lymphadenitis, 7(3.95%) metastatic malignancy, 2(1.13%) atypical lymphoid hyperplasia, 1(0.57%) myeloid sarcoma and 1(0.57%) chronic sialadenitis. Growth of MTB was on 23(22.55%) cases; among 102 granulomatous lymphadenitis and Gene Xpert was positive in 73(71.56%) cases with 100% Rif. sensitive. Gene Xpert is an important tool for diagnosis of tuberculous lymphadenitis. Time of symptoms to diagnosis of most of the TBL patients was within 2-8 months.

Serum Zinc Concentrations in Patients with Pulmonary Tuberculosis.

Bangladesh is a tuberculosis (TB) burden country. It is one of the most important causes of mortality and morbidity and a major barrier of social and economic development. Zinc is a major trace element and an essential component of the body immune system. It's an important determinant of resistance to infection by maintaining cell mediated immunity. This analytical case control study was conducted in the Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh to see the association of serum zinc concentrations with pulmonary tuberculosis (PTB) in adult population (18-60 years) from January 2015 to January 2016. Freshly diagnosed PTB patients before initiating anti-TB chemotherapy as cases (N=43) and TB negative subjects as controls (N=48) were included conveniently in this study with a rigid selection criteria. Serum zinc concentrations were estimated by using atomic absorption spectrophotometer. The mean±SD age and BMI of the case group and control group were 33.30±14.71 and 32.69±11.60 years, 19.88±2.31 and 22.08±2.80 kg/m2 respectively. The concentrations of serum zinc were significantly lower (P=0.01) in PTB group (840.9±230.0 µgm/l) compared with the control group (965.6±219.9 µgm/l). There was marked variation of mean±SD serum zinc concentrations between male (1008.95±246.16 µgm/l) and female (937.24±200.35 µgm/l) in control group (P=0.182) though the variation is minimal in PTB group (P=0.724). The serum zinc concentrations showed positive correlation with BMI (P=0.642) but negative correlation with age (P=0.023) in both case and control. The lower serum zinc concentrations (12.06%) in PTB patients indicate relative immune deficiency. Routine assessment of serum zinc concentration of PTB patients should be considered and further outcome should be assessed with zinc supplementation.

Particle size and charge distribution analysis of pharmaceutical aerosols generated by inhalers.

Aerosol particles generated by inhalers for respiratory drug delivery acquire electrostatic charge during the dispersion process. The electrostatic charge distribution of the particles can affect the efficiency of drug delivery by influencing both the transport and deposition of inhaled particles in the human lung. To analyze the electrostatic charge acquired by the aerosol particles, two sets of metered-dose inhaler (MDI) and dry powder inhaler (DPI) devices were investigated. Both the particle size and charge distributions were measured simultaneously by using an electrical single-particle aerodynamic relaxation time (E-SPART) analyzer. The analyzer was calibrated with particles of known size, which were generated by a vibrating orifice aerosol generator (TSI Inc.) and charge using the Faraday cup method. The charge distributions of the pharmaceutical aerosols from both the DPI and MDI devices were bipolar in nature. Although the net charge-to-mass ratio was less than 0.2 microC/g, the individual particles were charged with a relatively high charge: -2 to + 2 microC/g. The count mean aerodynamic diameter of the aerosols generated from these devices was 3-5 microm.

Plasma treatment of polyurethane coating for improving endothelial cell growth and adhesion.

The advantage of helium plasma treatment in enhancing endothelial cell growth and adhesion on polyurethane film coated on glass substrate is demonstrated with experimental data. Human coronary artery endothelial cell (HCAE) growth and attachment was studied on (1) bare glass substrate, used as control, (2) coated glass, with and without helium plasma treatment and (3) collagen-treated polyurethane-coated glass substrates. The untreated polyurethane film surface was rough (RMS = 690 nm) and highly hydrophobic (contact angle theta = 90 degrees). Cell growth on the untreated polyurethane surface was poor (cell concentration approximately 3750/cm2) compared to glass surface (cell concentration approximately 17 665/cm2). The atmospheric helium plasma treatment of the polyurethane film resulted in oxidation of the surface, a slight increase in roughness (RMS = 735 nm) and a significant drop in hydrophobicity (contact angle theta = 79 degrees). The critical surface tension (gamma c) of polyurethane film was also increased by 2 dynes/cm due to helium plasma treatment. These changes resulted in enhanced HCAE cell growth in polyurethane film (cell concentration approximately 16 230/cm2) compared to the untreated polyurethane film. The cell growth was also comparable to cell growth on a glass surface (17 665/cm2) and the collagen-treated polyurethane film surfaces (cell concentration approximately 21 645/cm2), respectively. Moreover, the strength of cell attachment on a plasma-treated surface (cell retention R = 89%) under laminar flow was significantly higher than that on a glass surface (R = 71%). While the collagen-treated polyurethane surface had the highest number of HCAE cells, the cell adhesion was found to be poor (R = 42%) compared to that of a plasma-treated surface. Thus, the overall performance of the plasma-treated polyurethane film surface on endothelial cell growth was better than other substrates studied here.

Corrosion resistance of polyurethane-coated nitinol cardiovascular stents.

Corrosion of metal stents implanted inside an artery can have two adverse effects: (1) tissue reaction and possible toxic effects from the metal ions leaching out of the stent, and (2) loss of mechanical strength of the stent caused by corrosion. The corrosion resistance of Nitinol (Nickel-Titanium) stents and its modulation with different film thickness of polymer coating was studied against an artificial physiological solution using a Potentiostat/Galvanostat and an electrochemical corrosion cell. The corrosion rate decreased rapidly from 275 microm/year for an uncoated surface down to less than 13 microm/year for a 30 microm thick polyurethane coating. Stainless steel (316L) and Nitinol both contain potentially toxic elements, and both are subject to stress corrosion. Minimization of corrosion can significantly reduce both tissue reaction and structural degradation.

Deposition of sidestream cigarette smoke in the human respiratory tract. II. Deposition of ultrafine smoke particles.

Sidestream cigarette smoke was generated into an inhalation chamber from which five normal male volunteers inhaled the smoke. Size distribution of the smoke aerosol was: count median diameter, 0.11 micron, mass median diameter 0.43 micron. Deposition fraction measured as concentration difference for each size fraction between inhaled and exhaled aerosol for each size interval was: 0.075 micron, 0.24 +/- 0.04; 0.13 micron, 0.15 +/- 0.04; 0.24 micron, 0.10 +/- 0.04; and 0.42 micron, 0.07 +/- 0.02. The declining deposition fraction as size approaches 0.5 micron is consistent with previous theoretical and experimental data.

Concentration and particle size distribution in smoke from marijuana cigarettes with different delta 9-tetrahydrocannabinol content.

Particle size and mass concentration are important determinants of site and quantity of respiratory tract deposition of aerosols. Particle concentrations and size distributions of smoke from marijuana cigarettes with different concentrations (as measured in the marijuana leaf) of delta 9-tetrahydrocannabinol (delta 9-THC) were measured using a single particle aerodynamic relaxation time (SPART) analyzer. The SPART analyzer measures aerodynamic diameter of single suspended particles at a rate of 3000/min. Cigarettes were smoked using a 35-cc, 2-sec puffing device attached to a diluter; dilution and analysis were completed within 4 sec of puff generation. The size distribution of smoke from all marijuana cigarettes was similar to that for tobacco cigarettes, ranging from 0.35 to 0.43 micron (count median aerodynamic diameter). The particle number and mass concentration increased as delta 9-THC concentration increased, being, respectively, 2.2- and 3.8-fold higher in the marijuana cigarette leaf with highest delta 9-THC concentration compared to the placebo marijuana cigarette. These data indicate the need for quantitative comparisons of other potentially toxic constituents in marijuana cigarettes of different delta 9-THC concentrations.

Aerodynamic sizing of tobacco smoke particulate from commercial cigarettes.

Aerodynamic sizing of smoke particulate was performed on a variety of commercial cigarettes using a single particle aerodynamic relaxation time (SPART) analyzer. Cigarettes tested were rated as "medium," "low," or "ultra-low" tar by the Federal Trade Commission method. Aerodynamic size determinations were made with filters attached and with filters removed. Smoke particles from all cigarettes were less than 0.6 micron mass median aerodynamic diameter, and particle size was not affected by filters. Commercial filters reduced particle number concentration by 20-96%. Particle number concentration of smoke particles from some "low" tar cigarettes was found to be similar to some "medium" tar cigarettes. Particle number per puff increased as the cigarette shortened. These findings suggest that estimation of tar delivery to smokers from cigarettes should include puff number information. Also, the ultimate respiratory tract deposition site of smoke particles is not affected by filters since particle size was not altered by passing smoke through cigarette filters.

Deposition of sidestream cigarette smoke in the human respiratory tract.

Measurement of deposition of sidestream cigarette smoke in the human respiratory tract is important for assessing the health effects of sidestream cigarette smoke. We measured the deposition fraction of sidestream cigarette smoke in 5 normal adult male volunteers using sidestream smoke at a concentration similar to that encountered indoors with smokers present. The mean deposition was 11%. These data indicate that the deposition fraction of sidestream smoke is similar to other previously studied aerosols in the same size range and is much less than mainstream smoke.

Physical properties of therapeutic aerosols.

This work describes results of measurements made to determine the size distribution of commonly used medical aerosols and the effect of high humidity on size distribution of some of those aerosols. If therapeutic aerosol particles change size considerably at high humidity, deposition quantity and site in the respiratory tract could be altered. If there is little change in size at high humidity, deposition could be estimated using theoretical deposition methods devised for deposition of stable particles. The results of this work suggest that the aerosol produced by most metered dose bronchodilator devices does not change size very much at high humidity.

Skin friction drag measurements by LDV.

A laser Doppler velocimeter employing a microscope objective as the receiving lens has been developed for measuring fluid velocity inside the boundary layer flow field with a spatial resolution of 40 microm. The method was applied for direct measurement of aerodynamic skin friction drag from the measured velocity gradient at the wall. Experimental results obtained on skin friction and on velocity components in a turbulent boundary layer on a low speed wind tunnel showed good agreement with previously reported data using conventional instruments such as hot-wire anemometers and Preston tubes. The method thus provides a tool for measurement and control of skin friction on aerodynamic bodies without perturbing the flow field.

Aerodynamic size distribution, hygroscopicity and deposition estimation of beclomethasone dipropionate aerosol.

Aerodynamic size distribution and aerodynamic mass per dose of beclomethasone dipropionate aerosol were measured at 24 and 95% relative humidity. At high humidity, the count median aerodynamic diameter was unchanged, mass median aerodynamic diameter increased from 2.01 micrometer to 2.68 micrometer, particle number/dose from 41.3 x 106 to 78.3 x 106, and aerodynamic mass per dose from 23.7 to 60.0 microgram. The quantity of active ingredient estimated to be in the 23.7 microgram aerodynamic mass at low humidity was 19.7 microgram. From data previously available describing average deposition fraction as a function of aerodynamic diameter, 6.7 microgram or 13% of the total dose of 50 microgram produced by the metered dose canister would be expected to deposit in the lower respiratory tract.

Effect of low and high relative humidity on metered-dose bronchodilator solution and powder aerosols.

Physical properties of two metered-dose bronchodilator aerosols packaged as solutions and two aerosols packaged as finely ground powders were measured at low and high relative humidity. The aerodynamic size distribution and particle concentration were measured in real time using the single-particle aerodynamic relaxation time analyzer, which can measure the aerodynamic diameter of single suspended particles in the respirable size range. The count median aerodynamic diameter, the mass per dose were calculated. Significant increases were noted in the count median aerodynamic diameter, the total particles per dose, and the total aerodynamic mass median aerodynamic diameter for three aerosols and in the mass median aerodynamic diameter for two aerosols. The number of particles in the measured size range increased 3.6- and 4.1-fold for the droplet aerosols and 1.4-fold for the powder preparations. The aerodynamic mass per dose in the measured size range increased 5.7- and 11.4-fold for the droplet aerosols and 3.1- and 1.6-fold for the powder aerosols. These data indicate that all aerosols tested increased in size at high humidity and that aerosols dispensed as droplets may be more unstable than those dispensed as powders.