A 60-year-old Man Presented with Relapsing Polychondritis with Haemophagocytic Lymphohistiocytosis.

Relapsing polychondritis is a rare autoimmune disorder of unknown etiology, which can affect multiple organs. It usually presents with involvement of elastic cartilage of ear and nose and involvement of other organs like kidney and central nervous system. Here, we report a case of 60-year-old man, who initially presented with fever, polyarthritis, erythema nodosum and painful swelling and redness of both external ears admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 13th December 2019. Two days after hospitalization, he developed sudden onset of proptosis with ophthalmoplegia. After evaluation, he was diagnosed as relapsing polychondritis with haemophagocytic lymphohistiocytosis and was treated with high dose prednisolone. His clinical condition and laboratory parameters significantly improved after treating with prednisolone during follow up.

Flexible oxygen concentrators for medical applications.

Medical oxygen concentrators (MOCs) are used for supplying medical grade oxygen to prevent hypoxemia-related complications related to COVID-19, chronic obstructive pulmonary disease (COPD), chronic bronchitis and pneumonia. MOCs often use a technology called pressure swing adsorption (PSA), which relies on nitrogen-selective adsorbents for producing oxygen from ambient air. MOCs are often designed for fixed product specifications, thereby limiting their use in meeting varying product specifications caused by a change in patient's medical condition or activity. To address this limitation, we design and optimize flexible single-bed MOC systems that are capable of meeting varying product specification requirements. Specifically, we employ a simulation-based optimization framework for optimizing flexible PSA- and pressure vacuum swing adsorption (PVSA)-based MOC systems. Detailed optimization studies are performed to benchmark the performance limits of LiX, LiLSX and 5A zeolite adsorbents. The results indicate that LiLSX outperforms both LiX and 5A, and can produce 90% pure oxygen at 21.7 L/min. Moreover, the LiLSX-based flexible PVSA system can manufacture varying levels of oxygen purity and flow rate in the range 93-95.7% and 1-15 L/min, respectively. The flexible MOC technology paves way for transitioning to an envisioned cyber-physical system with real-time oxygen demand sensing and delivery for improved patient care.

Incidence and Prevention of Biliary Leakage after Partial Liver Resection in a Tertiary Level Hospital.

Biliary leakage is a postoperative complication of liver resection which may have considerable consequences. The aim of this study is to evaluate the incidence of post hepatectomy biliary leakage and to find out the preventive measures by systemic literature reviews. This observational study was conducted on 500 patients who required various forms of hepatic resection at the Department of Hepatic Surgery - 4, Eastern Hepatobiliary Surgery Hospital of The Second Military Medical University, Shanghai, China from September 2014 to July 2016. Out of 500 cases 413(82.6%) were males and 87(17.4%) females with female to male ratio 1:4.75. A total 23(4.6%) patients developed biliary leakage after surgery. Incidence of biliary leakage was more 21/440 (4.8%) in malignant diseases. Intrahepatic cholangio carcinoma had highest 4/23 (17.4%) incidence of biliary leakage among malignant diseases. It was lowest 2/60 (3.3%) in benign diseases. Non anatomical resection found to have higher incidence 5/17 (29.4%) of biliary leakage. Among the anatomical resection left extended hepatectomy found more porn 2/6 (33.3%) to develop biliary leakage. No biliary leakage test was done in 111(22.2%) patients to prevent biliary leakage. In other patients biliary leakage tests were carried out and there was not much variation in incidence of biliary leakage. Maximum patients 380(76%) were discharged from the hospital within 11-15 days after operation. Patients with biliary leakage had higher hospital stay. There are still no standardized methods to prevent biliary leakage because of the lack of clear evidence that support their use. Therefore, the development of novel technical strategies to reduce biliary leakage is required.

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.

Investigation of change in surface area and grain size of cadmium titanate nanofibers upon annealing and their effect on oxygen sensing.

We have investigated the phase changes in CdTiO3 nanofibers as the annealing temperature of nanofibers was increased from 600 to 1200 °C. The nanofibers annealed at 600 °C were ilmenite with a very small amount of CdO. Upon annealing at 950 °C, CdO was completely removed. Annealing at 1000 °C yielded pure perovskite nanofibers, and at temperatures above 1100 °C rutile TiO2 nanofibers were obtained. Brunauer-Emmett-Teller (BET) analysis showed that with increase in annealing temperature the surface area of nanofibers was decreased. The nanofibers annealed at 600 °C have the higher surface area of ∼9.41 m(2)/g. Then oxygen sensors using CdTiO3 nanofibers annealed at 600 °C (ilmenite) and 1000 °C (perovskite) were fabricated. The sensitivity of the ilmenite nanofibers sensor was 2 times than that of the perovskite nanofibers sensor. The response and recovery times were 120 and 23 s, respectively, for the ilmenite nanofibers sensor, whereas response and recovery times were 156 and 50 s, respectively, for the perovskite nanofibers sensor. Better oxygen characteristics of ilmenite nanofibers are attributed to their large surface area and porosity. Therefore, we believe that ilmenite CdTiO3 nanofibers are potential candidates to develop practical oxygen sensors.

Anatomical and congenital anomalies of extra hepatic biliary system encountered during cholecystectomy.

Anomalous biliary anatomy is frequently encountered by surgeons during cholecystectomy. Importance of its recognition lies in avoiding serious biliary injuries. This study was carried out to assess the frequency of anatomical and congenital anomalies of extrahepatic biliary system in patients undergoing cholecystectomy. This is an observational study performed in the Department of Surgery, Combined Military Hospital (CMH) Momenshahi, CMH Ghatail and Mymensingh Medical College Hospital for a period of five years from June 2007 to June 2012. Two hundred and fifty diagnosed patients of cholelithiasis undergoing routine cholecystectomy were assessed for anatomical and congenital anomalies of extra hepatic biliary system as well as vascular anomalies. Structures mainly assessed for anomalies were gall bladder, cystic duct, supraduodenal part of Common Bile Duct (CBD), cystic artery and hepatic artery which are routinely handled during cholecystectomy. However, assessment of variations and anomalies, of hepatic ducts, portal vein, retroduodenal and pancreatic parts of CBD were not done due to possibility of iatrogenic injuries. Two hundred and fifty cases of cholelithiasis comprising 216(86.4%) females and 34(13.6%) males with mean age of 39.15 years were included in the study. Clinical presentation includes mainly pain in right hypochondrium (74.8%), pain in right hypochondrium and epigastrium (18.8%) and pain in epigastrium alone (7.6%). Laparoscopic cholecystectomy was done in 157 patients and 93 patients were treated by open procedure including conversion cases. Operative findings revealed variations in 38 cases (15.2%) mainly involving cystic artery (8%), cystic duct (4.4%) and gall bladder (1.6%). Postoperative complications includes bleeding 3.6%, biliary leak from drain 1.6% and CBD injury 0.8% giving rise to 0.8% morbidity, however, no mortality was seen in this series. Anatomical and congenital anomalies of biliary tree, are not common but may be significant during surgery as failure to recognize them leads to iatrogenic injuries and can increase morbidity and mortality.

An intervention for enhancing compliance with screening recommendations for diabetic retinopathy. A bicoastal experience.

OBJECTIVE: To determine whether an intervention at both the provider and patient level can increase the utilization of diabetic retinal examination among diabetic patients and to compare the results from a comparable study conducted on the East Coast. RESEARCH DESIGN AND METHODS: For the regional intervention study, all diabetic patients 18 years or older who enrolled in a large network-based health maintenance organization (HMO) in California were identified (n = 19,397). The identified diabetic patients received educational materials and a notification of their prior diabetic retinal examination status. Also, their primary care physicians received the current American Diabetes Association (ADA) guidelines for dilated retinal examinations and a list of patients due for diabetic retinal examination. RESULTS: There were 25 and 27% increases in the percentage of diabetic patients who received diabetic retinal examinations in 1995 compared with the percentages in 1993 and 1994, respectively. The increase in diabetic retinal examinations was most significant after the intervention (odds ratio = 1.4). Furthermore, the improvements in compliance after the intervention were almost identical between the studies implemented on the East and West Coasts. CONCLUSIONS: This study and the prior study demonstrate that such a "reminder" intervention can improve compliance with diabetic retinal screening recommendations. A generalizable intervention, such as this, may be applicable on a national level. For these programs to be successful, however, HMOs and physicians must have a collaborative relationship.