Allelopathic effect of the methanol extract of the weed species-red sorrel (Rumex acetosella L.) on the growth, phytohormone content and antioxidant activity of the cover crop - white clover (Trifolium repens L.).

Allelopathy is a biological process in which one organism releases biochemicals that affect the growth and development of other organisms. The current investigation sought to determine the allelopathic effect of Rumex acetosella on white clover (Trifolium repens) growth and development by using its shoot extract (lower IC50 value) as a foliar treatment. Here, different concentrations (25, 50, 100, and 200 g/L) of shoot extract from Rumex acetosella were used as treatments. With increasing concentrations of shoot extract, the plant growth parameters, chlorophyll and total protein content of Trifolium repens decreased. On the other hand, ROS, such as O2.- and H2O2, and antioxidant enzymes, including SOD, CAT, and POD, increased with increasing shoot extract concentration. A phytohormonal study indicated that increased treatment concentrations increased ABA and SA levels while JA levels were reduced. For the identification of allelochemicals, liquid‒liquid extraction, thin-layer chromatography, and open-column chromatography were conducted using R. acetosella shoot extracts, followed by a seed bioassay on the separated layer. A lower IC50 value was obtained through GC/MS analysis. gammaSitosterol was identified as the most abundant component. The shoot extract of Rumex acetosella has strong allelochemical properties that may significantly impede the growth and development of Trifolium repens. This approach could help to understand the competitive abilities of this weed species and in further research provide an alternate weed management strategy.

Plant-Entomopathogenic Fungi Interaction: Recent Progress and Future Prospects on Endophytism-Mediated Growth Promotion and Biocontrol.

Entomopathogenic fungi, often acknowledged primarily for their insecticidal properties, fulfill diverse roles within ecosystems. These roles encompass endophytism, antagonism against plant diseases, promotion of the growth of plants, and inhabitation of the rhizosphere, occurring both naturally and upon artificial inoculation, as substantiated by a growing body of contemporary research. Numerous studies have highlighted the beneficial aspects of endophytic colonization. This review aims to systematically organize information concerning the direct (nutrient acquisition and production of phytohormones) and indirect (resistance induction, antibiotic and secondary metabolite production, siderophore production, and mitigation of abiotic and biotic stresses) implications of endophytic colonization. Furthermore, a thorough discussion of these mechanisms is provided. Several challenges, including isolation complexities, classification of novel strains, and the impact of terrestrial location, vegetation type, and anthropogenic reluctance to use fungal entomopathogens, have been recognized as hurdles. However, recent advancements in biotechnology within microbial research hold promising solutions to many of these challenges. Ultimately, the current constraints delineate potential future avenues for leveraging endophytic fungal entomopathogens as dual microbial control agents.

SABR for Sarcoma Lung Metastases: Indications for Treatment and Guidance for Patient Selection.

PURPOSE: The lungs are the most common site of metastasis for patients with soft tissue sarcoma. SABR is commonly employed to treat lung metastases among select patients with sarcoma with limited disease burden. We sought to evaluate outcomes and patterns of failure among patients with sarcoma treated with SABR for their lung metastases. METHODS AND MATERIALS: We performed a retrospective review of patients treated at a tertiary cancer center between 2006 and 2020. Patient disease status at the time of SABR was categorized as either oligorecurrent or oligoprogressive. The Kaplan-Meier method was used to estimate disease outcomes. Uni- and multivariable analyses were conducted using the Cox proportional hazards model. RESULTS: We identified 70 patients with soft tissue sarcoma treated with SABR to 98 metastatic lung lesions. Local recurrence-free survival after SABR treatment was 83% at 2 years. On univariable analysis, receipt of comprehensive SABR to all sites of pulmonary metastatic disease at the time of treatment was associated with improved progression-free survival (PFS; hazard ratio [HR], 0.51 [0.29-0.88]; P = .02). On multivariable analysis, only having systemic disease controlled at the time of SABR predicted improved PFS (median PFS, 14 vs 4 months; HR, 0.37 [0.20-0.69]; P = .002) and overall survival (median overall survival, 51 vs 14 months; HR, 0.17 [0.08-0.35]; P < .0001). CONCLUSIONS: SABR provides durable long-term local control for sarcoma lung metastases. The most important predictor for improved outcomes was systemic disease control. Careful consideration of these factors should help guide decisions in a multidisciplinary setting to appropriately select the optimal candidates for SABR.

Common Pitfall in Post Operative Fluid and Electrolyte Management: A Retrospective Study in Two Tertiary Centers in Bangladesh.

Evaluation of our practice and recommend an appropriate fluid regime to maintain the fluid and electrolyte balance in the post operative period. The drug chart and clinical notes were retrospectively analysed manually of 758 patients who underwent surgery from January 2020 to January 2022 in Enam Medical College Hospital and Ibnsina Medical College Hospital, Dhaka, Bangladesh were reviewed by 3 individual clinicians and the obtained data were analysed. Total 407 patients met the inclusion criteria for the study. Fifty seven (57) patients underwent emergency operation and 350 patients had elective surgery. The average fluid replacement was 2.5 L/day, average Sodium- 154 mmol/day, average potassium 2.0 mmol/day and average glucose 125 mmol/day. Post operatively 97 patients developed hypokalemia. Among them 25 patients developed severe hypokalemia. A simple pathway for prescribing post operative fluid and electrolyte was proposed so that patients during 1st post operative day requiring maintenance fluid will have 25-30 ml/kg/day of water, approximately 1-2 mmol/kg/day Sodium and chloride, 1 mmol/kg/day of potassium and approximately 50-100 gm/day of glucose.

Outcomes after definitive treatment for cutaneous angiosarcomas of the face and scalp: Reevaluating the role of surgery and radiation therapy.

INTRODUCTION: We investigated outcomes and prognostic factors for patients treated for cutaneous angiosarcoma (CA). METHODS: We conducted a retrospective review of patients treated for CA of the face and scalp from 1962 to 2019. All received definitive treatment with surgery, radiation (RT), or a combination (S-XRT). The Kaplan-Meier method was used to estimate outcomes. Multivariable analyses were conducted using the Cox proportional hazards model. RESULTS: For the 143 patients evaluated median follow-up was 33 months. Five-year LC was 51% and worse in patients with tumors >5 cm, multifocal tumors, those treated pre-2000, and with single modality therapy (SMT). These remained associated with worse LC on multivariable analysis. The 5-year disease-specific survival (DSS) for the cohort was 56%. Tumor size >5 cm, non-scalp primary site, treatment pre-2000, and SMT were associated with worse DSS. CONCLUSION: Large or multifocal tumors are negative prognostic factors in patients with head and neck CA. S-XRT improved outcomes.

Characterization of Three Fusarium spp. Causing Wilt Disease of Cannabis sativa L. in Korea.

In July 2021, wilting symptoms were observed in adult and seedling hemp (Cannabis sativa L. cv. Cherry Blossom) plants grown in a greenhouse. As the disease progressed, yellowing and wilting symptoms on the leaves developed, resulting in whole plant death. In seedling plants, typical damping-off symptoms were observed. To identify the pathogen, the roots of diseased plants were sampled, surface sterilized, and cultured on potato dextrose agar (PDA) media. From the culture, 4 different fungal isolates were recovered and purely cultured. Each fungal isolate showed distinct growth shapes and color development on malt extract agar, oatmeal agar, sabouraud dextrose agar, and PDA media. Microscopic observation and molecular identification using ribosomal DNA internal transcribed spacer sequencing identified them as 3 Fusarium spp. and 1 Thielaviopsis paradoxa. Additional sequencing of elongation factor 1-alpha and ß-tubulin regions of 3 Fusarium spp. revealed that 2 of them are Fusarium solani, and the other one is Fusarium proliferatum. To examine which isolate can act as a causal agent of wilt disease of hemp, each isolate was tested for their pathogenicity. In the pathogenicity test, F. solani AMCF1 and AMCF2, and F. proliferatum AMCF3, but not T. paradoxa AMCF4, were able to cause wilting disease in hemp seedlings. Therefore, we report that F. solani AMCF1 and AMCF2, and F. proliferatum AMCF3 as causal agents of Fusarium wilt of hemp plants. To our knowledge, this is the first report of the wilt disease of C. sativa L. caused by Fusarium spp. in Korea.

Benchmarking Outcomes for Molecularly Characterized Synchronous Oligometastatic Non-Small-Cell Lung Cancer Reveals EGFR Mutations to Be Associated With Longer Overall Survival.

PURPOSE: Local consolidative therapy (LCT) for patients with synchronous oligometastatic non-small-cell lung cancer is an evolving treatment strategy, but outcomes following LCT stratified by genetic mutations have not been reported. We sought to identify genomic associations with overall survival (OS) and progression-free survival (PFS) for these patients. METHODS: We identified all patients presenting between 2000 and 2017 with stage IV non-small-cell lung cancer and ≤ 3 synchronous metastatic sites. Patients were grouped according to mutational statuses. Primary outcomes included OS and PFS following initial diagnosis. RESULTS: Of 194 included patients, 121 received comprehensive LCT to all sites of disease with either surgery or radiation. TP53 mutations were identified in 40 of 78 (55%), KRAS in 32 of 95 (34%), EGFR in 24 of 109 (22%), and STK11 in nine of 77 (12%). At median follow-up of 96 months, median OS and PFS were 26 (95% CI, 23 to 31) months and 11 (95% CI, 9 to 13) months, respectively. On multivariable analysis, patients with EGFR mutations had lower mortality risk (hazard ratio [HR], 0.53; 95% CI, 0.29 to 0.98; P = .044) compared with wild-type patients, and patients with STK11 mutations had higher risk of progression or mortality (HR, 2.32; 95% CI, 1.12 to 4.79; P = .023) compared with wild-type patients. TP53 and KRAS mutations were not associated with OS or PFS. Among 71 patients with known EGFR mutational status who received comprehensive LCT, EGFR mutations were associated with lower mortality compared with wild-type (HR, 0.45; 95% CI, 0.22 to 0.94; P = .032). CONCLUSION: When compared with wild-type patients, those with EGFR and STK11 mutations had longer OS and shorter PFS, respectively. EGFR mutations were associated with longer OS among oligometastatic patients treated with comprehensive LCT in addition to systemic therapy.

Radiation Therapy for Retroperitoneal Sarcomas: A Strass-Ful Situation.

Locoregional recurrence (LRR) is the predominant pattern of relapse and often the cause of death in patients with retroperitoneal sarcomas (RPS). As a result, reducing LRR is a critical objective for RPS patients. However, unlike soft tissue sarcomas (STS) of the superficial trunk and extremity where the benefits of radiation therapy (RT) are well-established, the role of RT in the retroperitoneum remains controversial. Historically, preoperative or postoperative RT, either alone or in combination with intraoperative radiation (IORT), was commonly justified for RPS based on extrapolation from the superficial trunk and extremity STS literature. However, long-awaited results were recently published from the European Organization for Research and Treatment of Cancer (EORTC) STRASS study of preoperative radiotherapy plus surgery versus surgery alone for patients with RPS; there was no statistical difference in the primary endpoint of abdominal recurrence-free survival. However, several subset analyses and study limitations complicate the interpretation of the results. This review explores and contextualizes the body of evidence regarding RT's role in managing RPS.

Gynecologic tract melanoma in the contemporary therapeutic era: High rates of local and distant disease progression.

BACKGROUND: Gynecologic tract melanoma (GTM) is a rare malignancy with historically poor outcomes. The current study examines patterns of care and oncologic outcomes in a large single-institution cohort from the contemporary therapeutic era. METHODS: Patterns of care and predictors of outcomes were evaluated for all GTM patients without metastatic disease at diagnosis who were treated at our institution between 2009 and 2020 with >6 months of follow-up. RESULTS: Of the 124 patients included, anatomic subsites were vulvar (n = 82, 66%), vaginal (n = 34, 27%), or cervical (n = 8, 6%). Primary tumor was resected for 85% (n = 106) with surgical nodal evaluation for 60% (n = 75). Systemic therapy, most commonly immune checkpoint inhibitors (ICI, 58% systemic therapy), was used to treat all except one unresectable patient (17/18) and 33% (35/106) of resectable patients. Seven patients received neoadjuvant ICI. Fourteen patients received adjuvant radiation therapy to the pelvis (RT, 13% of those undergoing resection). With a median follow-up of 45 months, 100 patients (81%) recurred. Four-year actuarial outcomes were: 46% local control, 53% nodal control, 36% distant metastasis-free survival, 17% disease-free survival, 49% melanoma-specific survival and 48% overall survival. Mitotic rate > 10/mm2, nodal involvement and non-vulvar anatomic subsite were associated with poor outcomes. Patients treated after 2016 did not have significantly better outcomes than those treated earlier. CONCLUSIONS: Patients with GTM continue to have poor outcomes in the contemporary therapeutic era with particularly notable poor local disease control relative to other mucosal melanoma subtypes. More effective oncologic therapy is needed.

Role of Transabdominal Ultrasonogram for Evaluation of Placental Maturity in Relation with Fetal Gestational Age.

In this study our main goal is to evaluate the role of ultrasonography (USG) for determination of placental maturity and fetal gestational age. This cross-sectional study was done at the Department of Radiology and Imaging (USG section) Mymensingh Medical College and Hospital, Mymensingh from July 2008 to June 2010, where 60 patients included in this study, who was attending in the department of Radiology & Imaging for transabdominal ultrasonography with early and late pregnancy related complaints. In this study among the 60 patients, the youngest one was eighteen years and oldest one was thirty-nine years old age. Thirty five percent (35.0%) patients were from 26-30 years age group. About 33 patients out of 60(55.0%) were house wives. Most of the patients were presented with amenorrhea (65.0%) 39 out of 60. Among 60 patients, 20 patients (33.3%) were in gestational age within 12-28 weeks, 20 patients (33.3%) were in gestational age within 29-36 weeks and 20 patients (33.3%) were within >36 weeks gestational age. Among them, 20 patients (33.3%) had grade III placenta, 20 patients (33.3%) had grade II placenta, 12 patients (20%) had grade I placenta and 08 patients (13.3%) had grade 0 placenta. Out of 60 patients, 18 patients (30.0%) were in high risk group and 70.0% were normal. Six (6) patients (10.0%) suffered from HTN, 3 patients had RH negative (5.0%) blood group, 3(5.0%) patients suffered from APH, 3 patients suffer from DM and 3 from IUGR. In this study showed hypertension and IUGR had strong correlation with accelerated placental maturation. Maternal DM and Rh sensitization were associated with delayed maturation of the placenta. This study concludes that, USG appears to be the best imaging modality for the evaluation of placenta and its grading. USG is relatively less expensive and it is good considering the diagnostic accuracy in pregnancy profile. It is noninvasive procedure without any radiation hazards and better visualization of the lesion in different section, but this study is not a complete reflection of overall incidence and statistics regarding the ailment in our country. For this a more extensive study over a longer period covering different section of society is very much needed for better outcome.

Clinical and Haematological Findings in Dengue Fever.

From 2000 onwards dengue fever has been occurring at regular intervals in Bangladesh. Ultrasonography is a useful diagnostic procedure. This study was done, keeping this background in mind. Objective of this study was to identify the role of ultrasonography as a useful tool in early diagnosis of dengue haemorrhagic fever. This was a cross-sectional descriptive type of observational study. Results of ultrasonography, haematogy an immunology were observed in 2004 and 2019 in 32 patients on each occasion. In 2004 out of 32 patients 29 had positive ultrsonographic findings supported by corresponding haematological and immunological findings. In 2019 ultrsonography was done in three out of thirty two patients, all three had had positive ultra sonographic findings which were supported by haematological and immunological findings. Dengue fever has serious complications like plasma leakage which manifest in the form of ascites, pleural effusion, thick gallbladder wall etc. If such complications can be detected at an early stage many lives can be saved.

Post-Operative Severe Hyperbilirubinemia: A Case Report.

Hyperbilirubinemia is commonly seen in medical practice. But what could be the highest level of bilirubin in an individual that is still an unanswered question. We came across to a 37 years old lady in October 2018 with hepaticolithiasis who underwent extended choledocholithotomy. Her preoperative serum bilirubin was within normal range. Post-operatively she developed cholangitis and from 3rd post-operative day onwards she developed severe hyperbilirubinemia, which was high as 70.47 mg/dl on the 6th post-operative day. Other causes of post-operative hyperbilirubinemia were excluded. She was managed conservatively for this hyperbilirubinemia and bilirubin level gradually reduced.

Outcomes After Sphincter-Sparing Local Therapy for Anorectal Melanoma: 1989 to 2020.

PURPOSE: The treatment paradigm for patients with anorectal melanoma eligible for sphincter-sparing excision has evolved over time. This study examines outcomes across a 30-year era in this rare disease with poor prognosis. METHODS AND MATERIALS: This retrospective cohort study included all patients with pelvis-confined anorectal melanoma undergoing sphincter-sparing local excision and adjuvant radiation therapy (RT) at our institution between 1989 and 2020. Patterns of care and predictors of outcome were evaluated. RESULTS: Of the 108 patients included, 92 (85%) presented with clinically uninvolved nodes. For clinically node-negative patients, the sentinel lymph node biopsy rate increased from 18/43 (42%) before 2008 to 38/49 (78%) subsequently and the use of inguinal nodal RT decreased from 33/35 (94%) before 2003 to 1/57 (2%) subsequently. All clinically node-positive patients treated before 2003 received inguinal nodal RT, whereas no node-positive patient treated subsequently received this treatment. Patients treated before 2016 mostly received biochemotherapy, and those treated since 2017 mostly received immune checkpoint inhibitors. With median follow-up of 32 months, 77 patients (71%) recurred. Three-year actuarial outcomes were 84% local control, 64% nodal control, 38% distant metastasis-free survival, 30% disease-free survival, and 51% melanoma-specific survival. Ostomy-free survival at last follow-up was 95%. Factors contributing to outcome were identified. Outcomes for patients treated in the contemporary era (2017+) were not significantly better than those treated earlier. CONCLUSIONS: Sphincter-sparing surgery followed by adjuvant RT results in excellent local control and ostomy-free survival for locally resectable anorectal melanoma. Overall oncologic outcomes continue to be poor, reinforcing the need to identify more effective therapies.

Ethanol Positively Modulates Photosynthetic Traits, Antioxidant Defense and Osmoprotectant Levels to Enhance Drought Acclimatization in Soybean.

Drought is a major environmental threat to agricultural productivity and food security across the world. Therefore, addressing the detrimental effects of drought on vital crops like soybean has a significant impact on sustainable food production. Priming plants with organic compounds is now being considered as a promising technique for alleviating the negative effects of drought on plants. In the current study, we evaluated the protective functions of ethanol in enhancing soybean drought tolerance by examining the phenotype, growth attributes, and several physiological and biochemical mechanisms. Our results showed that foliar application of ethanol (20 mM) to drought-stressed soybean plants increased biomass, leaf area per trifoliate, gas exchange features, water-use-efficiency, photosynthetic pigment contents, and leaf relative water content, all of which contributed to the improved growth performance of soybean under drought circumstances. Drought stress, on the other hand, caused significant accumulation of reactive oxygen species (ROS), such as superoxide and hydrogen peroxide, and malondialdehyde, as well as an increase of electrolyte leakage in the leaves, underpinning the evidence of oxidative stress and membrane damage in soybean plants. By comparison, exogenous ethanol reduced the ROS-induced oxidative burden by boosting the activities of antioxidant enzymes, including peroxidase, catalase, glutathione S-transferase, and ascorbate peroxidase, and the content of total flavonoids in soybean leaves exposed to drought stress. Additionally, ethanol supplementation increased the contents of total soluble sugars and free amino acids in the leaves of drought-exposed plants, implying that ethanol likely employed these compounds for osmotic adjustment in soybean under water-shortage conditions. Together, our findings shed light on the ethanol-mediated protective mechanisms by which soybean plants coordinated different morphophysiological and biochemical responses in order to increase their drought tolerance.

Biocontrol Activity of Aspergillus terreus ANU-301 against Two Distinct Plant Diseases, Tomato Fusarium Wilt and Potato Soft Rot.

To screen antagonistic fungi against plant pathogens, dual culture assay (DCA) and culture filtrate assay (CFA) were performed with unknown soil-born fungi. Among the different fungi isolated and screened from the soil, fungal isolate ANU-301 successfully inhibited growth of different plant pathogenic fungi, Colletotrichum acutatum, Alternaria alternata, and Fusarium oxysporum, in DCA and CFA. Morphological characteristics and rDNA internal transcribed spacer sequence analysis identified ANU-301 as Aspergillus terreus. Inoculation of tomato plants with Fusarium oxysporum f. sp. lycopersici (FOL) induced severe wilting symptom; however, co-inoculation with ANU-301 significantly enhanced resistance of tomato plants against FOL. In addition, culture filtrate (CF) of ANU-301 not only showed bacterial growth inhibition activity against Dickeya chrysanthemi (Dc), but also demonstrated protective effect in potato tuber against soft rot disease. Gas chromatography-tandem mass spectrometry analysis of CF of ANU-301 identified 2,4-bis(1-methyl-1-phenylethyl)-phenol (MPP) as the most abundant compound. MPP inhibited growth of Dc, but not of FOL, in a dose-dependent manner, and protected potato tuber from the soft rot disease induced by Dc. In conclusion, Aspergillus terreus ANU-301 could be used and further tested as a potential biological control agent.

The HRCT Evaluation of 105 Suspected COVID 19 Patients of MMCH and RT-PCR Correlation.

In this study our main goal is to evaluate the HRCT evaluation of 105 suspected COVID 19 patients of MMCH and RT-PCR correlation. This experimental and observational study was done at Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from May 2020 to October 2020. Where 105 suspected COVID 19 patients of MMCH and RT-PCR correlation were included in the study. During the study, 43.05% of the patients exposed indirectly to the virus, followed by 44.1% didn't exposed any virus, 21% exposed directly. Diabetes mellitus was 35.7%, HTN - 46.2%, 82.95% had fever, 72.45% had cough, 78.75% had respiratory distress and 49.35% had no diseases. After CT scan diagnosis, positive to infection were found in 98 patients, among them 34 patients had mild type, 22 had severe type of infection where as in RT-PCR diagnosis 69 were positive and 36 were negative to infection. From our study we can conclude that, the most common pattern of COVID-19 pneumonia on HRCT images are pure GGO and GGO and Crazy Paving. Also GGO with consolidation with prominent distribution in the posterior and peripheral part of the lung. Further study is very much needed for better outcome.

'There's a frog in my throat': bilateral prolapsing lung apices presenting as a neck lump.

This case report discusses an unusual presentation of a voluntarily produced neck mass, caused by the rare case of lung herniation. Lung herniation is associated with increased intrathoracic pressure that can be caused by chronic chough, straining and continuous positive airway pressure ventilation. An association with Ehlers-Danlos syndrome 1 also exists. We present a case of lung herniation that was multifactorial in nature and was identified at a head and neck clinic. The female patient presented with a voluntarily expandable anterior neck mass on Valsalva manoeuvre. Computed tomography imaging with and without Valsalva manoeuvre demonstrated bilateral anterior lung herniation and findings of spinal spondylosis.

Nodal Recurrence is a Primary Driver of Early Relapse for Patients with Sentinel Lymph Node-Positive Melanoma in the Modern Therapeutic Era.

BACKGROUND: Management of patients with sentinel lymph node (SLN)-positive melanoma has changed dramatically over the last few years such that completion lymph node dissection (CLND) has become uncommon, and many patients receive adjuvant immunotherapy or targeted therapy. This study seeks to characterize patterns and predictors of early recurrence in this setting. PATIENTS AND METHODS: All patients with primary cutaneous melanoma undergoing sentinel lymph node biopsy (SLNB) between 3/2016 and 12/2019 were identified. The subset with a positive SLN who did not undergo CLND were examined for further analysis of outcomes and predictors of recurrence. RESULTS: Overall, 215 patients with SLN-positive melanoma who did not have CLND were identified. Adjuvant systemic therapy was administered to 102 (47%), with 93% of this subset receiving immunotherapy (n = 95). Median follow-up from SLNB was 20 months (IQR 12-28.5 months), and 57 patients (27%) recurred during this time. The SLN basin was the most common site of recurrence (n = 38, 67% of recurrence), with isolated nodal recurrence being the most common first site of recurrent disease (n = 22, 39% of recurrence). On multivariable analysis, lymphovascular invasion (LVI) of the primary tumor, two or more involved nodes, and > 1 mm nodal deposit were independently associated with higher rates of nodal relapse. CONCLUSIONS: Nodal recurrence is a primary driver of early disease relapse for patients with SLN-positive melanoma who do not undergo CLND in the era of effective adjuvant systemic therapy. LVI, ≥ 2 nodes, or > 1 mm nodal disease identifies patients at particularly high risk of nodal relapse.

Description of a novel technique for creation of a custom-made prosthesis to aid vocalisation following laryngectomy.

There are various options to restore phonation after laryngectomy; one option involves using tracheo-oesophageal voice by placing a speaking valve through the tracheo-oesophageal wall. Some patients struggle to obtain good fixation of an adhesive base plate to the skin; this can result in air leakage and poor voice. We describe a technique using a custom-made prosthesis to provide a better base plate for fixation of the heat and moisture exchange cassette. This technique involves making an impression of the anterior neck around the laryngectomy stoma to create an anatomically fitted prosthesis, which accurately fills the void around the stoma. The custom-made prosthesis provides a more individualised fit compared to a standard base plate, helping improve vocalisation and communication.

Role of Angiographic Perfusion Score in Reperfusion Success and Risk Stratification Following Percutaneous Coronary Intervention in Acute Coronary Syndromes without Thrombolytic Pre-treatment.

Identifying the reperfusion success angiographically and predicting the prognosis is important following the Percutaneous Coronary Intervention (PCI). Though the assessment of successful PCI is still done by Thrombolysis in myocardial infarction (TIMI) Flow Grades (TFG), TIMI Myocardial perfusion grade (TMPG) is also a well accepted method of predicting outcomes in acute coronary syndrome (ACS) patients. Angiographic perfusion score (APS) that integrates both epicardial (TFG) and Myocardial tissue level perfusion (TMPG) before and after percutaneous coronary intervention may accurately measure the reperfusion success and predict Major adverse cardiac events (MACE) in ACS without any thrombolytic pre-treatment. This observational study was done in the Cardiology department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2014 to July 2015. With the appropriate methodological and statistical analysis, the data was drawn from the sample size of 60 eligible patients. APS (0-12) and post-procedure TMPG (0-3) alone were assessed following PCI in all eligible patients and then compared for the reperfusion success and short term (within 30days) clinical outcomes of MACE. Reperfusion success was identified significantly more in APS group versus TMPG alone (STEMI: 69.5% vs. 21.7% (p<0.05); Non STEMI/UA, late perfusion: 81.8% vs. 30.3% (p<0.05) respectively. A significantly lower incidence of MACE was found in the Full as compared to the Failed APS group (2.3% vs. 100%) (p<0.001). But no differences were observed between TMPG 1-3 (12.5%; 3.4% & 6.7%, respectively) (p=NS). Compared to TMPG alone, APS is a better reflector of reperfusion success as well as favorable predictor for short term clinical risk following PCI done during the index hospitalization in ACS.