Comparison of Pain Control and Analgesic Consumption With or Without Infiltration of Bupivacaine at Port Sites after Laparoscopic Cholecystectomy.

Pain management is an essential component of all surgical procedures. Analgesics are used for this purpose but there are some complications in using them. Local anesthetics like bupivacaine can be used to reduce postoperative pain as well as analgesics consumption. The objective of this study is to observe the result of infiltration of bupivacaine at port sites and to compare the postoperative pain relief with that of opioids and NSAID administration following laparoscopic cholecystectomy for chronic calculus cholecystitis. This is a cross sectional study was conducted over one year in the Department of Surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2018 to August 2019. Here total 40 patients were enrolled by purposive sampling. They were divided in two groups. One group received bupivacaine while other did not. A numerical pain scale was used as tool. Data will be recorded by peer reviewed interview and observation based semi structured data collection sheet. Data analysis was done by SPSS version 23.0. P-value was significant at (p<0.05) and determined by chi square test. Written informed consent was taken from the patient. The mean Numerical Rating Scale (NRS) score of pain at 6 hour was 2.55±0.6 in Group I and 6.8±1.15 in Group II. The mean NRS score of pain at 12 hour was 4.1±1.21 in Group I and 7.95±0.6 in Group II. The mean time of 1st analgesic administration was 13.85±1.57 hours in Group I and 2.75±0.72 hours in Group II. The mean repeat dose of analgesic was in 22±2.29 hours in Group I and 9.5±1.15 hours in Group II. In Group I one third patients (30.0%) single dose analgesic required in 1st 12 hours while in Group II almost 90.0% patients needed analgesics in 1st 12 hours. In Group I, total doses of analgesics required were 2 in 75.0% patients while in Group II at least 3 doses of analgesics were needed. In Group I only one patient needed analgesic in first 6 hours (5.0%) while in Group II, all the patients (100.0%) needed analgesics. The difference was statistically significant (p<0.05) between two groups. The patients receiving bupivacaine at port sites will experience less pain at postoperative period and will need less analgesic medications.

Demographic Characteristics of Patients with Breast Cancer in Bangladesh: A Single-Centre Study.

We performed this study to investigate the socio-demographic factors of breast cancer patients of Bangladesh. This cross-sectional study was conducted in the Department of General Surgery at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2018 to September 2019 for a period of one (1) year. All consecutive cases of breast carcinoma admitted in hospital and attended at outpatient department during the study period were selected as study population. Total 50 patients were selected. The mean age of the study patients was 51.1. Maximum number (70.0% cases) of breast cancer was belonged in 4th to 5th decade aged group. 70.0% breast cancer patients were housewives. The most of the breast carcinoma was reported in the urban people which were 78.0% cases. The percentage of educated study population was 80.0%. On religious background, 86.0% cases of breast cancer patients were Muslim. Most of breast cancer patients were sporadic in origin 94.0% cases, had no family history of breast cancer. Breast cancer was mostly distributed in pre-menopausal aged group with 82.0% cases. Ninety percent (90.0%) of the study population was come from middle class socio-economic group. In western countries, incidence of breast cancer is more in elderly aged menopause women with high socio-economic class. In this study the breast carcinoma was most prevalent among educated urban Muslim pre-menopausal housewives of age group 4th to 5th decade and most of them belonged to middle socio-economic class. The socio-demographic factors of breast cancer patients in Bangladesh are disparate from western countries in age standard, social class group and menstrual status.

Dye-sensitized InGaN nanowire arrays for efficient hydrogen production under visible light irradiation.

Solar water splitting is a key sustainable energy technology for clean, storable and renewable source of energy in the future. Here we report that Merocyanine-540 dye-sensitized and Rh nanoparticle-decorated molecular beam epitaxially grown In0.25Ga0.75N nanowire arrays have produced hydrogen from ethylenediaminetetraacetic acid (EDTA) and acetonitrile mixture solution under green, yellow and orange solar spectra (up to 610 nm) for the first time. An apparent quantum efficiency of 0.3% is demonstrated for wavelengths 525-600 nm, providing a viable approach to harness deep-visible and near-infrared solar energy for efficient and stable water splitting.

Visible light-driven efficient overall water splitting using p-type metal-nitride nanowire arrays.

Solar water splitting for hydrogen generation can be a potential source of renewable energy for the future. Here we show that efficient and stable stoichiometric dissociation of water into hydrogen and oxygen can be achieved under visible light by eradicating the potential barrier on nonpolar surfaces of indium gallium nitride nanowires through controlled p-type dopant incorporation. An apparent quantum efficiency of ∼12.3% is achieved for overall neutral (pH∼7.0) water splitting under visible light illumination (400-475 nm). Moreover, using a double-band p-type gallium nitride/indium gallium nitride nanowire heterostructure, we show a solar-to-hydrogen conversion efficiency of ∼1.8% under concentrated sunlight. The dominant effect of near-surface band structure in transforming the photocatalytic performance is elucidated. The stability and efficiency of this recyclable, wafer-level nanoscale metal-nitride photocatalyst in neutral water demonstrates their potential use for large-scale solar-fuel conversion.

Tuning the surface Fermi level on p-type gallium nitride nanowires for efficient overall water splitting.

Solar water splitting is one of the key steps in artificial photosynthesis for future carbon-neutral, storable and sustainable source of energy. Here we show that one of the major obstacles for achieving efficient and stable overall water splitting over the emerging nanostructured photocatalyst is directly related to the uncontrolled surface charge properties. By tuning the Fermi level on the nonpolar surfaces of gallium nitride nanowire arrays, we demonstrate that the quantum efficiency can be enhanced by more than two orders of magnitude. The internal quantum efficiency and activity on p-type gallium nitride nanowires can reach ~51% and ~4.0 mol hydrogen h(-1) g(-1), respectively. The nanowires remain virtually unchanged after over 50,000 µmol gas (hydrogen and oxygen) is produced, which is more than 10,000 times the amount of photocatalyst itself (~4.6 µmol). The essential role of Fermi-level tuning in balancing redox reactions and in enhancing the efficiency and stability is also elucidated.

Factors associated with thiopurine non-adherence in patients with inflammatory bowel disease.

BACKGROUND: Medication non-adherence seems to be a particular problem in younger patients with inflammatory bowel disease (IBD) and has a negative impact on disease outcome. AIMS: To assess whether non-adherence, defined using thiopurine metabolite levels, is more common in young adults attending a transition clinic than adults with IBD and whether psychological co-morbidity is a contributing factor. We also determined the usefulness of the Modified Morisky 8-item Adherence Scale (MMAS-8) to detect non-adherence. METHODS: Seventy young adults [51% (36) male] and 74 [62% (46) male] adults were included. Psychological co-morbidity was assessed using the Hospital Anxiety Depression Scale (HADS) and self-reported adherence using the MMAS-8. RESULTS: Twelve percent (18/144) of the patients were non-adherent. Multivariate analysis [OR, (95% CI), P value] confirmed that being young adult [6.1 (1.7-22.5), 0.001], of lower socio-economic status [1.1 (1.0-1.1), <0.01] and reporting higher HADS-D scores [1.2 (1.0-1.4), 0.01] were associated with non-adherence. Receiver operator curve analysis of MMAS-8 scores gave an area under the curve (95% CI) of 0.85 (0.77-0.92), (P < 0.0001): using a cut-off of <6, the MMAS-8 score has a sensitivity of 94% and a specificity of 64% to predict thiopurine non-adherence. Non-adherence was associated with escalation in therapy, hospital admission and surgeries in the subsequent 6 months of follow up. CONCLUSIONS: Non-adherence to thiopurines is more common in young adults with inflammatory bowel disease, and is associated with lower socio-economic status and depression. The high negative predictive value of MMAS-8 scores <6 suggests that it could be a useful screen for thiopurine non-adherence.

Imaging slit-coupled surface plasmon polaritons using conventional optical microscopy.

We develop a technique that now enables surface plasmon polaritons (SPPs) coupled by nano-patterned slits in a metal film to be detected using conventional optical microscopy with standard objective lenses. The crux of this method is an ultra-thin polymer layer on the metal surface, whose thickness can be varied over a nanoscale range to enable controllable tuning of the SPP momentum. At an optimal layer thickness for which the SPP momentum matches the momentum of light emerging from the slit, the SPP coupling efficiency is enhanced about six times relative to that without the layer. The enhanced efficiency results in distinctive and bright plasmonic signatures near the slit visible by naked eye under an optical microscope. We demonstrate how this capability can be used for parallel measurement through a simple experiment in which the SPP propagation distance is extracted from a single microscope image of an illuminated array of nano-patterned slits on a metal surface. We also use optical microscopy to image the focal region of a plasmonic lens and obtain results consistent with a previously-reported results using near-field optical microscopy. Measurement of SPPs near a nano-slit using conventional and widely-available optical microscopy is an important step towards making nano-plasmonic device technology highly accessible and easy-to-use.

Factors associated with nonadherence to thiopurines in adolescent and adult patients with inflammatory bowel disease.

OBJECTIVES: We hypothesised that nonadherence to thiopurines is more common in adolescents than in adults with inflammatory bowel disease. METHODS: We sought factors associated with thiopurine nonadherence defined by thiopurine metabolite levels. RESULTS: Multivariate logistic regression confirmed that adolescents (odds ratio [OR] 4.6 [95% confidence interval [CI] 1.9-11.5]; P < 0.01) compared with adults, patients with Crohn disease (OR 3.3 [CI 1.1-10.5] P = 0.04) compared with ulcerative colitis, and patients living in more socially deprived areas (OR 1.03 [CI 1.0-1.1] P = 0.02) were more likely to be nonadherent to thiopurines. CONCLUSIONS: Adolescents are more frequently nonadherent than adults: prospective studies are required to determine the reasons for nonadherence in adolescents.

Misdiagnosis in epilepsy: a review and recognition of diagnostic uncertainty.

The diagnosis of first seizure or epilepsy may be challenging and misdiagnosis can occur. Studies carried out in various settings have reported misdiagnosis rates of between 4.6% and 30%. Misdiagnosis can lead to serious consequences including driving and employment restrictions and inappropriate treatments. Most studies focus on ways of reducing misdiagnosis. However, in some cases, it may be difficult to make a definite diagnosis at initial presentation. This is because of a number of reasons including overlapping clinical features with other conditions, inadequate available history and limitations of investigations. Consequently, diagnostic uncertainty is inevitable in epilepsy, although few studies acknowledge this. In this paper we review the literature on misdiagnosis rates, analyse reasons for misdiagnosis and consider limitations of available investigations. We propose that diagnostic uncertainty in epilepsy should be more widely acknowledged and addressed, and that this may reduce misdiagnosis rates.

Study on Mycobacterium tuberculosis: the primary drug resistance pattern.

The study was carried out to investigate the primary drug resistance pattern of tubercle bacilli isolated from the pulmonary tuberculosis patient attended in Shyamoli TB clinic, Dhaka. Sputum from 961 suspected tuberculous patients were randomly collected and stained by Ziehl-Neelsen (Z.N) stain. 135 were microscopically positive for Acid Fast Bacilli (AFB). Among them 30 patients were excluded from the study as they received antitubercular treatment before. So only 105 microscopically positive cases were cultured on Lowenstein-Jensen (L-J) media and 100 showed pure growth and rest 5 were contaminated with fungus. These 100 cases were studied on 4 antitubercular drugs. Out of these 100 isolates, 91 were M. tuberculosis and rest 9 in the nonchromogen group of mycobacteria other than tuberculosis (MOTT) species. Among 91 M. tuberculosis species, 89 (97.80%) to Isoniazid (INH), 73 (80.21%) to Rifampicin (RMP) and 91 (100%) to Streptomycin (SM) and Ethambutol (ETHM) were sensitive. Of the 9 MOTT species, 4 (44.44%) to SM, 7 (77.78%) to ETHM were sensitive and all (100%) were resistant to INH and RMP. Among the 100 isolates, 27 (18 M. tuberculosis and 9 MOTT) were resistant to 4 drugs either single or in combination. Of the 18 (66.67%) M. tuberculosis species, 16 (59.26%) to RMP, and 2 (7.41%) to RMP and INH were resistant. Of the 9 (33.33%) MOTT species, 4 (14.81%) to RMP and INH, 3 (11.11%) to RMP, INH and SM and 2 (7.41%) to RMP, INH, SM and ETHM were resistant.

The transformation in vitro of peripheral lymphocytes of malnourished children.

Children with protein energy malnutrition showed high deranged cellular immunity as evidenced by impairment of lymphocyte transformation after stimulation by phytohaemagglutination (PHA). The proliferative response (PR) to PHA measured by estimating incorporation of tritiated thymidine into newly synthesized DNA. In-vitro proliferative response to PHA was used as a marker for studying the functional characteristics of T lymphocytes of children with different categories of malnutrition. PHA response of peripheral blood lymphocytes obtained from different categories of severely malnourished children were significantly low compared to healthy control children (P < 0.01). The results indicate that cell mediated immunity was grossly depressed in severe malnutrition.