Evaluation of Antimicrobial Efficacy and Clinical Outcomes of Triphala and 2.5% Sodium Hypochlorite as Intraradicular Irrigants in Pulpectomy of Primary Teeth.

A natural irrigation solution with a broad spectrum of antimicrobial coverage, triphala was selected for the pulpectomy procedure. Because of its natural ingredients, it is well-known for promoting tissue healing. It also supposedly has certain additional qualities as compared to usual irrigation solutions that are made chemically. Although 2.5% NaOCl is thought to be perfect since it meets most of the requirements for an irrigation solution but it cannot be optimized for pulpectomy procedure. Primary teeth that were recommended for pulpectomy underwent this randomized controlled experiment. Two groups of eighty-four primary teeth were randomly assigned to receive irrigations: triphala in Group A; 2.5% Sodium hypochlorite in Group B. Sample were taken from infected primary root canals. A sterile test tube with bhi broth as the transport media was used to collect pre- and post-irrigation samples using sterile absorbent paper tips. On agar media, microorganisms were cultivated and their mean colony count was assessed. Following the procedure, the patient's follow-up visits at one, two and three months were used to evaluate the clinical result. The post-microbial colony count was dramatically reduced (p<0.001) by both irrigation treatments. Triphala in Group A is demonstrating desirable efficacy. Clinical success was found satisfactory in both the groups studied (p<0.001). But statistically significant difference was not found (p=0.175). Considering undesirable properties of sodium hypochlorite triphala can be a better alternative as a root canal irrigants in pulpectomy of primary teeth.

Mental Health Assessment of Health Care Providers of Bangladesh during Covid-19 Pandemic: A Cross-Sectional Web-Based Study.

SARS COV 2 raised immense agony to everyone. As health care workers remains direct contact with patients, they are vulnerable to mental health disorder. The study was done to identify mental health status of health care providers of Bangladesh. It was a cross sectional web based survey among health care providers of bangladesh. A structured web based questionnaire was prepared both in Bangla and English version for better understanding. Total 2594 health care workers responded to online survey. Male were 1303(50.2%) and female were 1291(49.8%). Occupational demography shows 98.5% were physicians. Mean value of patient health questionnaire 9 (PHQ9) and generalized anxiety disorder (GAD) were 8.43±6.082 and 8.27±5.234 respectively among healthcare providers. To overcome anxiety and depression, 93.4% of HCW didn't receive any psychological material and 85.6% HCW didn't find physiological resources even through media. Despite many lacking, healthcare workers were resilient in our study.

Study of Operative Events and Time Requirement of Hepaticoduodenostomy for the Treatment of Type I Choledochal Cyst- the Experience at BSMMU Hospital.

Of all varieties, Type I Choledochal cyst causing saccular or fusiform dilatation of the extra-hepatic biliary ductal system is the commonest (90.0 - 95.0%). Its presentations vary. To restore the continuity of the extra-hepatic biliary tract after excision of type I Choledochal cyst, surgeons have few alternatives to use, with their advantages and disadvantages. Roux en-Y Hepatico-jejunostomy (RYHJ) has been very popular and long studied standard surgical treatment for type I Choledochal cyst. But now Hepatico-duodenostomy (HD) is also being practiced and studied in different centers all over the world for the treatment of the same disease. For the last five years, we, at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, have been using Hepatico-duodenostomy as preferred anastomotic option in treating type I Choledochal cyst. Here, we are presenting our experience at BSMMU Hospital, regarding operative events and time requirement of Hepaticoduodenostomy for the treatment of type I Choledochal cyst and, to show whether this procedure can be safely practiced, producing acceptable results. It is a retrospective document study, from January 2013 to December 2017, at BSMMU Hospital, on forty two, MRCP confirmed type I Choledochal cyst patients of pediatric age. Patients' particulars, history, physical examination, investigations (including MRCP confirmation), assessment, surgical plan were collected from relevant medical records and documented in duly coded individual data collection sheet maintaining standard privacy protocol. Information regarding presentations, operative findings and procedural events including per-operative mortality, injury to the vital structures during operation, conversion to RYHJ, operative time (minutes), blood loss and transfusion requirements (ml) of Heaticoduodenostomy for type I Choledochal cyst, were specially searched for. There was no operative mortality. None of these patients required per-operative blood transfusion. Nor there was any inadvertent injury to the adjacent structures. The mean operative time required for Hepaticoduodenostomy was 88 minutes with a range of 75 to 125 minutes. Through this study, at BSMMU Hospital, operative events and time requirement of Hepatico-duodenostomy for treating type I Choledochal cyst, was found to be yielding acceptable results, for safe practice.

Clinico-epidemiological Characteristics of Asymptomatic and Symptomatic COVID-19-Positive Patients in Bangladesh.

As of August 15, 2020, Bangladesh lost 3591 lives since the first Coronavirus disease 2019 (COVID-19) case announced on March 8. The objective of the study was to report the clinical manifestation of both symptomatic and asymptomatic COVID-19-positive patients. An online-based cross-sectional survey was conducted for initial recruitment of participants with subsequent telephone interview by the three trained physicians in 237 adults with confirmed COVID-19 infection in Bangladesh. The study period was 27 April to 26th May 2020. Consent was ensured before commencing the interview. Collected data were entered in a pre-designed case record form and subsequently analyzed by SPSS 20.0. The mean±SD age at presentation was 41.59±13.73 years and most of the cases were male (73.0%). A total of 90.29% of patients reside in urban areas. Among the positive cases, 13.1% (n=31) were asymptomatic. Asymptomatic cases were significantly more common in households with 2 to 4 members (p=0.008). Both symptomatic and asymptomatic patients shared similar ages of presentation (p=0.23), gender differences (p=0.30) and co-morbidities (p=0.11). Only 5.3% of patients received ICU care during their treatment. The most frequent presentation was fever (88.3%), followed by cough (69.9%), chest pain (34.5%), body ache (31.1%), and sore throat (30.1%). Thirty-nine percent (n=92) of the patients had co-morbidities, with diabetes and hypertension being the most frequently observed. There has been an upsurge in COVID-19 cases in Bangladesh. Patients were mostly middle-aged and male. Typical presentations were fever and cough. Maintenance of social distancing and increased testing are required to meet the current public health challenge.

National TB Control Program of Bangladesh: System Failure and Loss of Effectiveness.

The National Tuberculosis Control Program (NTP) is one of the largest programs run by the state with many successes. However, underreporting is considered a real flaw of the current program. To report the characteristics and outcomes of TB patients registered in an upazila health complex in Kazipur, Sirajganj district, Bangladesh between September 2018 and February 2019 under the control of NTP was the objective of the study. This retrospective cohort study was conducted using routinely collected program data from the aforementioned site. Data retrieved from the hospital record form. Formal permission was obtained from the local authority. Consent statements and ethical aspects were waived due to the retrospective nature of the study. Analysis was performed using SPSS 20.0. A total of 207 tuberculosis cases were included with an average age of presentation of 43 years. Approximately 82.0% had pulmonary tuberculosis (PTB) and the rest had extrapulmonary tuberculosis (EPTB). PTB was more common in males, whereas EPTB was common in females (p=0.01). Of all cases, 84.0% were diagnosed by a positive sputum smear and 16.0% were diagnosed clinically with a negative sputum smear. Attendance at follow-up was 82.12%, 70.04% and 68.59% at months 2, 5 and 6 following index admission respectively. Overall, the cure rate was higher in PTB than EPTB [146 (85.9%) vs. 5 (13.5%), p<0.001). The rate of treatment completion was 25.1% (n=52) and the death count was 1.4% (n=3) [PTB-1.2 (n=2) vs. EPTB-2.7% (n=1)]. A gradual decline in reporting or completion of treatment was observed in this setting. However, a nationwide study is warranted to explore this issue in detail.

Global Stability Analysis and Parameter Estimation for a Diphtheria Model: A Case Study of an Epidemic in Rohingya Refugee Camp in Bangladesh.

In this article, we have developed a deterministic Susceptible-Latent-Infectious-Recovered (SLIR) model for diphtheria outbreaks. Here, we have studied a case of the diphtheria outbreak in the Rohingya refugee camp in Bangladesh to trace the disease dynamics and find out the peak value of the infection. Both analytical and numerical investigations have been performed on the model to find several remarkable behaviors like the positive and bounded solution, basic reproductive ratio, and equilibria such as disease extinction equilibrium and disease persistence equilibrium which are characterized depending on the basic reproductive ratio and global stability of the model using Lyapunov function for both equilibria. Parameter estimation has been performed to determine the values of the parameter from the daily case data using numerical technique and determined the value of the basic reproductive number for the outbreak as ℛ 0 = 5.86.

Open Label Randomized Controlled Comparison of Three Alternative Regimes of Ciprofloxacin, Azithromycin and Cefixime for Treatment of Uncomplicated Typhoid Fever in Bangladesh.

Multi-drug resistant Typhoid fever (resistant to previously used chloramphenicol, ampicillin, amoxicillin, and trimethoprim-sulfamethoxazole) has been commonly described in the South East Asia region and a recent report suggests that the salmonella typhi have reduced response to fluoroquinolones (nalidixic acid-resistant). The optimum treatment protocol for this type of serovar has not been established. This study compared different antimicrobial regimens for the treatment of uncomplicated typhoid fever which was conducted in the medicine ward of Dhaka Medical College Hospital (DMCH) and outdoor setting in private practice in Dhaka metropolitan city, Mymensingh and Sylhet town from January 2017 to December 2017. Bangladeshi adults with uncomplicated typhoid fever were included in this an open-label randomized controlled trial. Ciprofloxacin (20mg/kg of body weight/day for 14 days), azithromycin (20mg/kg/day for 14 days), and Cefixime (16mg/kg/day for 14 days) were compared. Of the 81 enrolled patients, 62 were eligible for analysis (61 S. enterica serovar Typhi, 1 Salmonella enterica serovar paratyphi A). Of the S enterica serovar Typhi isolates, 88.7% (55/62) were MDR and 93.5% (58/62) were nalidixic acid resistant (NAR). The clinical cure rate was 62% (13/21) with ciprofloxacin, 71% (15/21) with Cefixime, and 85% (17/20) with azithromycin (p=0.053). The mean (95% confidence interval [CI]) fever clearance time for patients treated with azithromycin (5.8 days [5.1 to 6.5 days]) was shorter than that for patients treated with cefixime (7.1 days [6.2 to 8.1 days]) and ciprofloxacin (8.2 days [7.2 to 9.2 days]) (p<0.001). All three antibiotics were well tolerated. A 7-day course of azithromycin can be successfully used in uncomplicated typhoid fever due to isolates of MDR S enterica serovar Typhi.

Study of Immediate Postoperative Outcome of Hepaticoduodenostomy for the Treatment of Type I Choledochal Cyst: The Experience at BSMMU Hospital.

Excision of type I choledochal cyst mandates restoration of continuity of extrahepatic biliary drainage system through anastomotic options having their advantages and disadvantages. Roux en-Y Hepaticojejunostomy (RYHJ) has been very popular and long studied standard surgical treatment for type I choledochal cyst. But now Hepaticoduodenostomy (HD) is also being practiced and studied in different centers all over the world for the treatment of the same disease. We have been practicing Hepaticoduodenostomy for treating type I choledochal cyst, at Bangabandhu Sheik Mujib Medical University (BSMMU), for last five years. Here, we are presenting our experience at BSMMU Hospital, regarding immediate post-operative outcome of Hepaticoduodenostomy for the treatment of type I Choledochal cyst, to show whether this procedure can be safely practiced, producing acceptable results. It is a retrospective document review of forty two MRCP confirmed type I Choledochal cyst children, admitted and operated at BSMMU Hospital, from January 2013 to December 2017. Patient's particulars, history, physical examination, investigations (including MRCP confirmation), assessment, surgical plan were collected from relevant medical records under standard privacy protocol. Information regarding early post-operative outcome of Hepaticoduodenostomy in treating uncomplicated type I choledochal cyst were searched for review and evaluation, specifically with respect to- a) mortality (if any); b) morbidities like- i) prolonged post-operative abdominal pain, ii) anastomotic bile leak, iii) features of early Cholangitis, iv) wound dehiscence and c) prolonged Hospital stay. There was no immediate post-operative mortality. But 9(21.42%) patients had prolonged post-operative pain requiring parenteral Pethidine 'on demand' beyond second post-operative day, 2(4.76%) had anastomotic bile leak, 7(16.67%) had early cholangitis and 1(2.38%) had abdominal wound dehiscence; they (21.42%) also stayed in hospital for more than fourteen days. The outcome was acceptably safe when compared with other studies abroad. Through this study, at BSMMU Hospital, immediate post-operative outcome of Hepaticoduodenostomy for treating type I choledochal cyst- in terms of morbidity, mortality and hospital stay- was found to be yielding acceptable results, for safe practice.

Management of a Subgingivally Fractured Maxillary Central Incisor by Reattachment Technique.

Reattachment of a fractured fragment to the remaining tooth is challenging but one of the best treatment protocols in regards to aesthetics, function as well as patients acceptance. If the original tooth fragment is retained following fracture, the natural tooth structures can be reattached using adhesive protocols to ensure reliable strength, durability and aesthetics. This case report will discuss a 13 years old boy with a complicated crown-root fracture of maxillary right central incisor tooth. The procedure used to repair the fracture regarding this case including flap surgery with endodontic treatment. The root canal was filled with a root canal sealer and gutta-percha. After root canal obturation, fragment was reattached with an adhesive tooth reattachment technique. After 6 months evaluation, clinical and radiographic examinations showed a stable re-attachment, good aesthetic and healthy periodontium.

Evaluation of Corrosion and Tarnishing of Intra-oral Nickel Chromium and Gold-alloy Cast Crown.

Although esthetic factors might limit by the presentation of materials used, all-metal complete cast crown should always be offered to patients requiring restoration of endodontically treated posterior tooth. The complete cast crown has the highest longevity of all fixed restorations. It could be used to rebuild a single tooth or a retainer for a fixed prosthesis. It involves all the axial walls as well as the occlusal surface of the tooth to be restored. All restorations are placed in the oral environment in contact with the gingival tissue. Thus clinicians must choose nontoxic or least toxic metal alloys, since any release of elements that might cause reactions. This study was designed to observe clinical responses of nickel chromium alloy and gold alloy cast crown and provide guidance to ascertain the best alloy for cast metal crown, which serves better functional restoration.

Feasibility and Safety of Distal Transradial Access in the Anatomical Snuffbox for Coronary Angiography and Intervention.

Distal transradial access in the anatomical snuffbox has advantages over standard proximal access in terms of patient and operator comfort levels and risk of ischemia. Radial artery preservation could be a relevant issue in patients requiring multiple radial artery procedures and coronary bypass with the use of a radial graft or construction of Arterio-Venous fistula in patient of chronic kidney disease. One relevant drawback is the challenging puncture of a small and weak artery, with a steeper learning curve. The study was aimed at proving feasibility and safety of distal transradial access in the anatomical snuffbox. A total of 100 patients were assigned to perform coronary angiogram or intervention through distal transradial access in the anatomical snuffbox from January 2018 to June 2018 in this unit of the University Cardiac Center (UCC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. All of them had normal pulse in their distal radial artery. Both right and left distal radial artery were used and demographic features & complications were recorded during hospital stay. Statistical analysis was done through SPSS version 19. The overall feasibility was 98%, greater than expected in this early clinical experience, with 98 successful accesses out of 100 patients. There was failure to access of distal radial artery in two cases which may be due to hypoplastic/vasospastic distal radial artery. Despite all it can be said that it was very much safe as there was no hand ischemia, hematoma, numbness or proximal radial arterial occlusion. Distal transradial access in the anatomical snuffbox for coronary angiography and intervention is a safe and feasible option for both patients and operators.

Study on Endoscopic Retrograde Cholangiopancreatography.

Endoscopic retrograde cholangiopancreatography (ERCP) is a modern & universally established modality in the evaluation and treatment of suspected biliary and pancreatic disease. In Bangladesh, ERCP services are limited to few tertiary care centers mostly in the capital & large city. ERCP was 1st introduced in Mymensingh on 3rd April 2016 in a private hospital. Since then, Mymensingh Medical College Hospital (MMCH) provides ERCP services to a large volume of patients in collaboration with private center for diagnostic accuracy & therapeutic purpose. The aim of this study was to evaluate our experience in ERCP, to characterize & evaluate the aetiology, findings of ERCP & frequency of complications. This prospective type of study was carried out by the department of hepatology, MMCH from 3rd April 2016 to 10th July 2018 in collaboration with that private center where ERCP has been established. All patients undergoing ERCP during this period were included. Aetiology & findings were assessed at the time of ERCP & complications were assessed during procedure, index hospitalization & within 30 days after the procedure by telephone contact. A total of 301 consecutive ERCP were performed during the study period. Among them, 182(60.5%) were male & 119(39.5%) were female with an age range of 18-78 years. The most common indications for ERCP were: cholangiocarcinoma in 98(32.56%) & choledocholithiasis in 95(31.56%) followed by periampullary growth in 93(30.89%), suspected CBD stricture in 12(4%) & chronic pancreatitis in 2(0.66%). The most common findings were choledocholithiasis (32.56%), cholangiocarcinoma (32.56%), biliary obstruction due to periampullary growth (30.56%). Biliary fistula with distal bile duct stricture was found in (1.66%), bile duct stricture in (1.33%), chronic pancreatitis in (0.66%), and organic papillary stenosis with deformed bulb were discovered in (0.34%) case. All ERCPs were done for therapeutic purpose. Endoscopic sphincterotomy was the most common therapeutic procedure (87.04%) of which biliary stenting was done in (67.44%) & stone extraction in (33.71%). Stone extraction from biliary tree was successfully done in 94 cases (98.67%) but it was unsuccessful from biliary tree in 4 cases (1.33%) & also from pancreatic duct in a separate case. The most frequent complication was Post-ERCP pancreatitis in 9 patients (2.99%) followed by acute confusional state (1.33%). Post-ERCP cholangitis occurred in (0.99%) & death was reported in 2 cases (0.66%) due to anaesthetic hazard.

Visceral Adiposity Index Score is the Better Predictor of Clinical and Coronary Angiographic Severity Assessment than Other Adiposity Indices in Patients with Acute Coronary Syndrome.

Acute coronary syndrome (ACS) is one of the leading causes of death throughout the world and obesity especially visceral adiposity is one of the important concerns globally due to its huge impact on coronary artery disease particularly on ACS. There are several traditional methods like BMI, WC, WHR, WHtR etc. but none of these can measure visceral fat accurately. In this regard visceral adiposity index (VAI) is a novel sex specific index which has significant correlation with visceral adiposity and can express the distribution as well as function of visceral fat precisely. This cross sectional study was done in the Cardiology Department of National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from August 2015 to July 2016 to compare the VAI with other adiposity indices for clinical and coronary angiographic severity assessment in patients with acute coronary syndrome. A total of 200 patients (Case 100 patients of ACS and Control 100 patients of non ACS) were included. Afterward clinical, biochemical, echocardiographic and coronary artery angiographic indexes determined by Gensini score were acquired. Adiposity indices like BMI, Waist and Hip circumference, Waist Hip and Waist Height ratio (WHR, WHtR) and finally VAI were calculated using appropriate formula. Patient with ACS had more severe form of clinical features like severe chest pain & shortness of breath (p=0.001), pulse, BP, abnormal precordial findings, BMI, WC, WHR, WHtR, HC, VAI (p=0.001) and angiographic severity (p=0.001) than non ACS group. Multivariate binary logistic regression analysis for clinical and coronary angiographic severity assessment (GS>36) by adiposity indices showed VAI was the better predictor of clinical and coronary angiographic severity assessment with OR's being 5.61 than others. An ROC curve was plotted for each adiposity indices for clinical and coronary angiographic severity assessment showed VAI to have the maximal AUC. A VAI of OR-5.61 was provided as the cutoff value which had a sensitivity of 73.3% and specificity of 76.6% (AUROC=0.839, CI-0.760-0.918, p<0.001) which indicates better than other adiposity indices in patients under study. VAI is an excellent, simple, noninvasive tool to detect the visceral adipose mass & was markedly associated with the clinical and coronary angiographic severity assessment in patients with ACS.

Transcatheter Closure of Post Infarction Subacute Ventricular Septal Defect: A Case Report.

Ventricular septal rupture (VSR) is an uncommon but lethal complication of acute myocardial infarction (MI). Although early surgical closure is the treatment of choice, hospital mortality after emergency surgery remains high. Transcatheter closure of post myocardial infarction ventricular septal defect (PIVSD) has emerged as a potential treatment option in selected cases. Herein, we report a case present in AFC Health FORTIS Heart Institute, Khulna, Bangladesh on 10 February 2017 of sub acute post-MI VSR that was successfully closed using an Amplatzerseptal occlude (ASD) device. The patient had undergone primary percutaneous coronary intervention (PCI) 15 days earlier in the setting of acute MI.

Comparison between Glyceryl Trinitrate and Trimetazidine in Ischaemic Cardiomyopathy Patients.

Ischaemic cardiomyopathy (ICM) remains a major health problem, both in developed and developing countries like Bangladesh where it causes a significant number of morbidity and mortality. The treatment and outcome of ICM chiefly depends on the presence and extent of hibernating myocardium. In this regard addressing anginal symptoms is the key to patients' comfort as well to achieving the goal of treatment. Glyceryl trinitrate (GTN) and trimetazidine (TMZ) are two widely used drugs for relieving angina. This pilot study was designed to answer some of the confusions and controversies regarding their use and to bring precision in decision making in the treatment of ICM. Here, comparison of GTN and trimetazidine were done by assessing the symptoms by NYHA and CCS class following their use in ICM patients, admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from 15th October, 2015 to 15th April, 2016, who were randomly placed in two groups in a prospective manner. Most of the patients were in age group 51-60 years and were male in both the groups. It was observed that there was no significant difference in NYHA and CCS class at base line and at discharge between two groups (p>0.05). But statistically significant (p<0.05), improvement noted at 6 weeks and 12 weeks in GTN group in comparison to trimetazidine group. GTN stood out to be a better option than TMZ in the treatment of ICM. Moreover GTN is a cheaper option than TMZ.

Age and Gender-dependent Correlates as Risk Factors of Recurrent Headache among Bangladeshi Secondary School Children.

Magnitude of recurrent headache (RHA) is not well explored among school-children (schoolers) particularly in developing countries like Bangladesh, though recent literature reveals that RHA connotes serious public health implication(s) particularly in schoolers in resource constraint countries. To study age and gender-dependent correlates of RHA among secondary-level schoolers and to determine if these remains its risk-factors. Cross-sectional population based respondent-dependent study employing direct interviews using pre-tested open and closed-ended questionnaire following ICHD-II (2004) diagnostic criteria. Overall, 17% RHA was observed among 1499 schoolers surveyed initially, being more in pubertal/adolescents (13-15 years) than pre-pubertal (11-12 years) ones. Of screened-out 255 RHA positive cases, migraine (MHA) was observed in 55.3% while tension-type-headache (TTH) in 19.6% schoolers. RHA demonstrated a steady-inclining trend with schooler's age. Gender difference was obvious in MHA (p<0.001) but not in TTH (p<0.31). Pubertal schoolers (OR=8.75) and boys (OR=1.8) remained at greater risk for migraine but less risky for TTH. Mass-awareness program is imperative to prevent RHA among schoolers towards progressing it into chronicity, psycho-socially handicapped and economically burdened. Further in-depth studies warrant prudent data to examine its long-term risks/underlying factors involving more diverse population (school-children) from different geographical areas and cultural contexts.

Modulation of a compressional electromagnetic wave in a magnetized electron-positron quantum plasma.

Amplitude modulation of a compressional electromagnetic wave in a strongly magnetized electron-positron pair plasma is considered in the quantum magnetohydrodynamic regime. The important ingredients of this study are the inclusion of the external strong magnetic field, Fermi quantum degeneracy pressure, particle exchange potential, quantum diffraction effects via the Bohm potential, and dissipative effect due to collision of the charged carriers. A modified-nonlinear Schödinger equation is developed for the compressional magnetic field of the electromagnetic wave by employing the standard reductive perturbation technique. The linear and nonlinear dispersions of the electromagnetic wave are discussed in detail. For some parameter ranges, relevant to dense astrophysical objects such as the outer layers of white dwarfs, neutron stars, and magnetars, etc., it is found that the compressional electromagnetic wave is modulationally unstable and propagates as a dissipated electromagnetic wave. It is also found that the quantum effects due to the particle exchange potential and the Bohm potential are negligibly small in comparison to the effects of the Fermi quantum degeneracy pressure. The numerical results on the growth rate of the modulation instability is also presented.

Temporal and Physiologic Measurements of Deglutition in the Upright and Supine Position with Videofluoroscopy (VFS) in Healthy Subjects.

Cross-sectional imaging has long been employed to examine swallowing in both the sagittal and axial planes. However, data regarding temporal swallow measures in the upright and supine positions are sparse, and none have employed the MBS impairment profile (MBSImP). We report temporal swallow measures, physiologic variables, and swallow safety of upright and supine swallowing in healthy subjects using videofluoroscopy (VFS). Twenty healthy subjects ages 21-40 underwent VFS study upright and supine. Subjects were viewed in the sagittal plane and swallowed 5 mL liquid and pudding barium. Oral transit time, pharyngeal delay time, pharyngeal response time, pharyngeal transit time, and total swallow duration were measured. Penetration/aspiration scores and 14 MBSImP variables were analyzed in both positions. All subjects completed swallows supine, although one aspirated on one liquid bolus. Temporal measures of swallowing were similar for pudding upright and supine. Pharyngeal phase swallow measures were longer for liquids in supine. MBSImP physiologic measures revealed a pharyngeal delay in both positions. Although Pen/Asp range was higher supine, more subjects penetrated upright. Temporal measures were increased for liquids in supine. Although Pen/Asp range was higher in supine, more subjects penetrated upright. These results provide support for cross-sectional supine imaging of swallowing for pudding, but perhaps not thin liquids for dysphagic patients. Slightly thicker liquids might prove reliable in supine without compromising swallow safety. Future research should examine swallow physiology in both positions in dysphagic and older healthy subjects.

Age-Related Changes in Pharyngeal Lumen Size: A Retrospective MRI Analysis.

Age-related loss of muscle bulk and strength (sarcopenia) is often cited as a potential mechanism underlying age-related changes in swallowing. Our goal was to explore this phenomenon in the pharynx, specifically, by measuring pharyngeal wall thickness and pharyngeal lumen area in a sample of young versus older women. MRI scans of the neck were retrospectively reviewed from 60 women equally stratified into three age groups (20s, 60s, 70+). Four de-identified slices were extracted per scan for randomized, blinded analysis: one mid-sagittal and three axial slices were selected at the anterior inferior border of C2 and C3, and at the pit of the vallecula. Pixel-based measures of pharyngeal wall thickness and pharyngeal lumen area were completed using ImageJ and then converted to metric units. Measures of pharyngeal wall thickness and pharyngeal lumen area were compared between age groups with one-way ANOVAs using Sidak adjustments for post-hoc pairwise comparisons. A significant main effect for age was observed across all variables whereby pharyngeal wall thickness decreased and pharyngeal lumen area increased with advancing age. Pairwise comparisons revealed significant differences between 20s versus 70+ for all variables and 20s versus 60s for all variables except those measured at C2. Effect sizes ranged from 0.54 to 1.34. Consistent with existing sacropenia literature, the pharyngeal muscles appear to atrophy with age and consequently, the size of the pharyngeal lumen increases.

Evaluation of Physicochemical Deterioration and Lipid Oxidation of Beef Muscle Affected by Freeze-thaw Cycles.

This study was performed to explore the deterioration of physicochemical quality of beef hind limb during frozen storage at -20℃, affected by repeated freeze-thaw cycles. The effects of three successive freeze-thaw cycles on beef hind limb were investigated comparing with unfrozen beef muscle for 80 d by keeping at -20±1℃. The freeze-thaw cycles were subjected to three thawing methods and carried out to select the best one on the basis of deterioration of physicochemical properties of beef. As the number of repeated freeze-thaw cycles increased, drip loss decreased and water holding capacity (WHC) increased (p<0.05) till two cycles and then decreased. Cooking loss increased in cycle one and three but decreased in cycle two. Moreover, drip loss, WHC and cooking loss affected (p<0.05) by thawing methods within the cycles. However, pH value decreased (p<0.05), but peroxide value (p<0.05), free fatty acids value (p<0.05) and TBARS value increased (p<0.05) significantly as the number of repeated freeze-thaw cycles increased. Moreover, significant (p<0.05) interactive effects were found among the thawing methods and repeated cycles. As a result, freeze-thaw cycles affected the physicochemical quality of beef muscle, causing the degradation of its quality.