A rare case of vomiting: fourth ventricular B-cell lymphoma.

We document the case of a 69-year-old man presenting with 6 weeks of intractable vomiting. Magnetic Resonance Imaging showed a homogenously enhancing mass in the caudal fourth ventricle. Surgical exploration and biopsy was performed and pathological examination demonstrated a high-grade B-cell lymphoma. The lesion was a primary tumour in an immuno-competent patient. Despite the increasing incidence of primary central nervous system lymphomas this is believed to be only the third ever case to have occurred at this rare site. We suggest that primary B-cell lymphoma should be considered with homogenous lesions of the fourth ventricle.

Deep tubewell microbial water quality and access in arsenic mitigation programs in rural Bangladesh.

The objective of this paper is to determine whether deep tubewells installed through arsenic mitigation efforts in rural Bangladesh provide better drinking water microbial quality compared to shallow tubewells. We conducted a stratified random cross-sectional survey of 484 households to assess microbial contamination of deep tubewell water at source and at point of use (POU) compared to shallow tubewell water using the Compartment Bag Test. In addition, we measured storage time, distance, travel time and ownership status among both sets of users to assess deep tubewell efficacy and under what conditions they offer poorer or better water quality. Differences in tubewell characteristics were compared using non-parametric Mann-Whitney U tests and two-proportion Z-tests. Prevalence ratios of microbial contamination stratified by water quality, storage time and distance to tubewells and ownership were estimated using unadjusted Mantel-Haenszel tests. There was no significant difference in microbial contamination between shallow and deep tubewells at source. The presence of POU water microbial contamination in storage containers in deep tubewell households was 1.11 times the prevalence in shallow tubewell storage containers (95% CI = 0.97-1.27). Deep tubewell users stored water longer and walked significantly farther to obtain water compared to shallow tubewell users. Among deep tubewell households, those residing farther away from the source were 1.24 times as likely to drink contaminated water from storage containers compared to those located nearby (95% CI = 1.04-1.48). Our findings suggest that deep tubewells have comparable water quality to shallow tubewells at source, but increasing distance from the household exacerbates risk of microbial contamination at POU.

Mucocele of appendix with an elevated carcinoembryonic antigen: A case report.

Mucocele of the appendix is an uncommon disease in which there is cystic dilatation of the appendix caused by mucus secretion and usually associated with benign or malignant causes. Preoperative diagnosis is difficult as the patient presents with non-specific clinical symptoms. We report a case of mucocele of the appendix with elevated serum carcinoembryonic antigen (CEA) - a condition sparsely reported in literature. Patient presented with pain in the right iliac fossa for 7 months. On exploration, a cystic mass of the appendix without perforation was found in right iliac fossa. There was no lymph nodes enlargement. Appendicectomy was performed with subsequent normalization of CEA level and histopathology confirmed the diagnosis of mucinous neoplasm of the appendix. Patient is feeling well after one year of follow up.

Same admission colostomy closure: a prospective, randomised study in selected patient groups.

BACKGROUND: Despite a recent trend towards primary repair, colostomy still has an important place in the management of different colorectal pathologies. Timing of colostomy closure is a debatable issue among general surgeons. We carried out a prospective, randomised study to compare the outcome after same admission colostomy closure (SACC) and conventional delayed colostomy closure (CDCC) in patients with predominantly traumatic injury of the large bowel. METHODS: Sixty patients, the majority with traumatic colorectal pathologies, were prospectively randomised to SACC [30 patients, 23 men, mean age 27.9 +/- 9.7 (range, 18-65) years] or (CDCC) [30 patients, 24 men, mean age 28.6 +/- 10.6 (range, 18-63) years]. All colostomies were closed using an intraperitoneal closure technique. Pre-operative data and post-operative outcomes were collected and analysed. RESULTS: A total of seven patients (23.3%) with SACC developed complications compared with eight patients (26.6%) having CDCC (p = 0.83). The mean hospital stay (p < 0.01), as well as the overall cost (p < 0.001), were significantly less in the SACC group. CONCLUSIONS: Same admission colostomy closure is a safe and cost-effective technique for colostomy closure in selected groups of patients.

Hybrid machine learning technique for forecasting Dhaka stock market timing decisions.

Forecasting stock market has been a difficult job for applied researchers owing to nature of facts which is very noisy and time varying. However, this hypothesis has been featured by several empirical experiential studies and a number of researchers have efficiently applied machine learning techniques to forecast stock market. This paper studied stock prediction for the use of investors. It is always true that investors typically obtain loss because of uncertain investment purposes and unsighted assets. This paper proposes a rough set model, a neural network model, and a hybrid neural network and rough set model to find optimal buy and sell of a share on Dhaka stock exchange. Investigational findings demonstrate that our proposed hybrid model has higher precision than the single rough set model and the neural network model. We believe this paper findings will help stock investors to decide about optimal buy and/or sell time on Dhaka stock exchange.

Prevalence and presentation of chronic venous disease in Pakistan: a multicentre study.

Our objective was to study the prevalence and clinical pattern of chronic venous disease (CVD) in the Pakistani population. This was a multicentre cross-sectional study in which 100 primary care physicians examined 3000 subjects. The study population was aged 18-95 years (mean ± SD = 39 ± 13.2) comprised 47.4% women and 52.6% men. The prevalence of CVD was 34.8%, being significantly higher (P < 0.04) among men (36.4%) than women (33.0%). The maximum prevalence was of C3 (36.7%), followed by C2 (15.8%). The most frequent symptom was pain in the legs (59.2%) followed by heavy legs (42.7%) and night cramps (34.4%). The prevalence of symptoms increased with age but was similarly distributed between men and women. Family history of CVD, blood clots in veins and lack of exercise were significant risk factors. The roles of age or gender as risk factors could not be established. In conclusion, the prevalence and presentation of CVD in Pakistan is similar to most other countries.

International migration and the "moral" economy of the "Barani" peasantry.

PIP: International migration and the "barani" peasantry are explained in terms of a subsistence ethic in rainfed agricultural areas of northern Pakistan. It is postulated that economic decisions of the "barani" are rational and are part of a willed order which reflects the economic, political, social and cultural aspects of a deliberately organized style of living. This functional structure is discussed in terms of the motivational concerns of the "biraderi" and the kinship and worksharing patterns and the household structure. There is selectivity in the migration pattern and the decision is made with the collective welfare of the household in mind. The migrant profile is one of single, young males about 24-35 years; most fall in the 26-32 age group. 67% are unmarried, but there is motivation to marry in order to make claims on fathers' lands and fulfill dowry payments and become more marriageable. Also, villagers desire to expand the number of "biraderi" which strengthens the socioeconomic foundation. Marriage is also related to earning potential. The migration impact is felt in terms of the absence, which results in a loss of labor, but usually households cope effectively. Another impact was one of remittances, which make a considerable difference in household income. From a sample of households taken in 1980-1984, over 65% of migrant households received over 75% of their income from migrant labor. Only 1 household received 50% of their income from migrant labor. It is estimated that 64% of annual migrant's earnings and 87% of migrant's savings were remitted. The impact was also felt in the use of remittances, which in order to importance, satisfied the needs of the households, their aspirations, and access to investment opportunities. A significant portion of income was spent on basic needs: food, clothing/footwear, and other related items, and health. A portion also went to savings. This occurred in order to achieve security and a measure of control over their lives. In poorer households, satisfaction of basic needs and a threshold of savings took precedence over housing improvements. Priorities were established. Security is achieved eventually in the investment in housing since most poor households lived in mud and straw ("kutcha") or bricks and cement ("pukka") prior to migration. These structures needed repair after the monsoons. Respectability is attained through purchase of land, and most desire this end. Access is limited however due to unavailability and high prices. Social standing is also attained through spending on marriages, hospitality, deaths, pilgrimages, and cultural feasts. Acquisition of consumer durables is associated with a higher socioeconomic profile and occurs mostly among the better off. Poor migrants purchase these items for resale. Land investments were made for development of rent yielding commercial plots.^ieng