Early Outcome of On-pump Versus Off-pump Elective Surgical Revascularization in Patients with Prior ST-Segment Elevation Myocardial Infarction.

Coronary artery bypass graft surgery (CABG) is a proven treatment for coronary artery disease. History of a ST-elevation myocardial infarction (STEMI) is considered an independent risk factor for CABG irrespective of timing for an emergency or elective surgery. Patients with STEMI are candidates for both On-pump and Off-pump CABG procedures. This paper discusses the possible best option for elective surgical revascularization in patients with prior STEMI. This prospective clinical trial of 60 eligible patients with prior STEMI was conducted in a Tertiary Care Hospital from April 2018 to March 2019. Among them, 30 patients underwent off-pump (Group A) and 30 patients underwent on-pump (Group B) CABG procedures. Outcomes between both groups were observed from surgery to 1 month postoperatively. Data was analysed by the software statistical program for social science (SPSS 25.0 Inc). The surgery was successful in both groups of patients. Differences were observed by mean number of grafts per patient (2.77±0.43 vs. 3.10±0.71) and duration of operation (4.41±0.35 hours vs. 5.71±0.48 hours). An improvement in Left Ventricular Ejection Fraction (LVEF %) was observed in both groups postoperatively (17.98% vs. 10.98%) and the postoperative LVEF% at different time points were found statistically significant (p<0.05) over preoperative LVEF%. Multivariable stepwise logistic regression analysis correlated on-pump CABG with prolonged need for ionotropic support, need for blood transfusion, longer hospital stay and less improvement in LVEF%. The study supports the Off-pump CABG as a better surgical option over on-pump CABG in patients with prior STEMI.

Comparison of Recurrent Laryngeal Nerve Injury during Thyroidectomy with and Without Routine Identification of the Nerve Peroperatively.

Thyroidectomy is one of the commonest operative procedures performed in the neck and injury to recurrent laryngeal nerve (RLN) is not uncommon. It results in hoarseness to serious respiratory distress depending on the extent of the injury. The incidence of RLN injury varies widely and is multifactorial depending on the extent of surgical procedures, experience and expertise of the surgeons, nature of the thyroid diseases and a wide range of anatomical variations. Peroperative routine identification of the nerve during thyroidectomy can be a way to prevent injury. Despite recommendation for identification of the RLN peroperatively in thyroid surgery, a debate still exists whether the nerve to be identified peroperatively or not, to avoid its inadvertent injury. The aim of this study was to compare the incidence of RLN injury between two groups where RLN was identified peroperatively in one group and the nerve was not attempted for identification in the other group in thyroid surgery. A comparative cross-sectional study was carried out in the department of surgery and otolaryngology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from June 2018 to November 2019, on patients who underwent elective thyroid surgery. Patients were included in RLN identified group and in RLN not identified group, by individual surgeons' preference to identify or not to identify the RLN peroperatively. Peroperative identification of the nerve was done by direct visualization. All cases were evaluated for vocal cord palsy preoperatively, during extubation and postoperatively. Patient's particulars, other parameters and perioperative data were recorded. A total of 80 cases were included in this study, 40 cases (50.0%) in the peroperative RLN identified group and 40 cases (50.0%) in the RLN not identified group. Unilateral RLN palsy was encountered in 2.5% (2 cases) in the RLN identified group and 6.3% (5 cases) in the nerve not identified group (p value 0.192). Transient unilateral RLN palsy was seen in 7.5% (6 cases) of patients; 2.5% (2 cases) in the RLN identified group and 5.0% (4 cases) in the RLN not identified group. And 1.3% (1 case) of permanent unilateral RLN palsy was encountered in this study, which was in the RLN not identified group; there was no permanent palsy in the RLN identified group. We did not encounter any bilateral RLN palsy. There was no statistically significant difference in the incidence of RLN injury between the peroperatively RLN identified group and no attempt to identify the nerve group despite recommendation for peroperative RLN identification in thyroid surgery to avoid its inadvertent injury. However, from this study, we recommend peroperative RLN identification in thyroid surgery to enhance surgical skill.

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.

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.

Effect of Nystatin with and without DMAHDM on Antifungal and Mechanical Properties of Acrylic Resins.

PURPOSE: To investigate antifungal and mechanical properties after the impregnation of Dimethyl Amino-ethyl Hexa-decyl Di-methacrylate (DMAHDM) alone or in combination with Nystatin in polymethylmethacrylate. METHODOLOGY: The control group was fabricated by mixing powder and liquid of PMMA at the ratio of 2.5:1 g/mL. The DMAHDM was added to PMMA liquid and were mixed with PMMA powder. The Nystatin (500,000 International Units (IU)) was mixed with PMMA powder, whereby the composite powder was mixed with the DMAHDM-based liquid. The prepared specimens were tested for fungal adhesion testing (at days 1 and 30), impact strength and flexural strength. Oneway ANOVA post-hoc Tukey's test were used for statistical analysis. RESULTS: Statistical analysis for the adhesion assay revealed that the antifungal activities of unaged and aged specimens in experimental groups were statistically significant as compared to control group A. The groups containing DMAHDM with Nystatin have shown statistically reduced flexural strength. The impact strength test revealed that groups containing 20% DMAHDM alone and DMAHDM with Nystatin showed statistically reduced impact strength compared to the control group. CONCLUSION: Antifungal activities of experimental PMMA resin was increased. The addition of DMAHDM alone in PMMA resin has no deleterious effects on impact and flexural strength, however, at higher concentration values were reduced.

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.

Effects of different combinations of N, P and K at different time interval on vegetative, reproductive, yield and quality traits of mango (Mangifera Indica. L) cv. Dusehri / Efeitos de diferentes combinações de N, P e K em diferentes intervalos nas características vegetativas, reprodutivas, produtivas e de qualidade da manga (Mangifera indica. L) cv. Dusehri

The experiment was carried out on mango cv. Dusehri to investigate the effect of N, P and K fertilizers on vegetative, reproductive growth, yield and fruit quality. Eight different fertilizer combinations such as T1 (control), T2 (N), T3 (P), T4 (K), T5 (NP), T6 (NK), T7 (PK) and T8 (NPK) were used. Individual or combine fertilizer application of N (1000 g), P (750 g) and K (750 g) were applied during growing season in February and August. All the treatments significantly influenced on vegetative growth, flowering, fruiting, yield and other physiochemical attributes of mango as compared to control. Least effect was observed with individual fertilizer application while combine fertilizer treatments enhanced most of the investigated parameters. Especially, qualitative traits showed nonsignificant differences between treated and untreated mango trees. However, among the different treatments T8 (NPK) showed significance for fruiting aspects such as maximum size of growth flushes (177.51 mm), total number of panicles/tree (845), total number of flowers/panicle (974), sex ratio (69.18%), fruit retention (13.85%), total number of fruits/tree (379), yield (82 kg/tree), fruit weight (197.5 g), pulp weight (135.5 g) and physiochemical parameters namely TSS (24.53), Vit. C (57.63 mg/100 mL) and total sugar (20.84%). In general, combine application of NPK (T8) were the most effective in enhancing fruiting aspects, yield, physiochemical characteristics as well as improved fruit quality of mango trees.

O experimento foi realizado em manga cv. Dusehri para investigar o efeito dos fertilizantes N, P e K no crescimento vegetativo, reprodutivo, produtividade e de qualidade do fruto. Foram utilizadas oito combinações diferentes de fertilizantes: T1 (controle), T2 (N), T3 (P), T4 (K), T5 (NP), T6 (NK), T7 (PK) e T8 (NPK). Cada tratamento de N (1.000 g), P (750 g) e K (750 g) foi aplicado duas vezes durante a estação de crescimento em fevereiro e agosto. Todos os tratamentos influenciaram significativamente o crescimento vegetativo, floração, frutificação, produtividade e outros atributos físico-químicos da manga em relação ao controle. Menos efeito foi observado com a aplicação individual de fertilizante, enquanto os tratamentos combinados aumentaram a maioria dos parâmetros investigados. Especialmente as características qualitativas mostraram diferenças não significativas entre mangueiras tratadas e não tratadas. No entanto, entre os diferentes tratamentos, T8 (NPK) apresentou significância para aspectos de frutificação, como tamanho máximo de folgas de crescimento (177,51 mm), número total de panículas/árvore (845), número total de flores/panícula (974), razão sexual (69,18%), retenção de frutos (13,85%), número total de frutos/árvore (379), produção (82 kg/árvore), peso do fruto (197,5 g) e peso da polpa (135,5 g), além de parâmetros físico-químicos, como TSS (24,53), vitamina C (57,63 mg/100 mL) e açúcar total (20,84%). Em geral, a aplicação combinada de NPK (T8) foi a mais eficaz no aprimoramento dos aspectos de frutificação, produtividade, características físico-químicas, além da melhoria da qualidade dos frutos das mangueiras.

Effects of different combinations of N, P and K at different time interval on vegetative, reproductive, yield and quality traits of mango (Mangifera Indica. L) cv. Dusehri / Efeitos de diferentes combinações de N, P e K em diferentes intervalos nas características vegetativas, reprodutivas, produtivas e de qualidade da manga (Mangifera indica. L) cv. Dusehri

The experiment was carried out on mango cv. Dusehri to investigate the effect of N, P and K fertilizers on vegetative, reproductive growth, yield and fruit quality. Eight different fertilizer combinations such as T1 (control), T2 (N), T3 (P), T4 (K), T5 (NP), T6 (NK), T7 (PK) and T8 (NPK) were used. Individual or combine fertilizer application of N (1000 g), P (750 g) and K (750 g) were applied during growing season in February and August. All the treatments significantly influenced on vegetative growth, flowering, fruiting, yield and other physiochemical attributes of mango as compared to control. Least effect was observed with individual fertilizer application while combine fertilizer treatments enhanced most of the investigated parameters. Especially, qualitative traits showed non significant differences between treated and untreated mango trees. However, among the different treatments T8 (NPK) showed significance for fruiting aspects such as maximum size of growth flushes (177.51 mm), total number of panicles/tree (845), total number of flowers/panicle (974), sex ratio (69.18%), fruit retention (13.85%), total number of fruits/tree (379), yield (82 kg/tree), fruit weight (197.5 g), pulp weight (135.5 g) and physiochemical parameters namely TSS (24.53), Vit. C (57.63 mg/100 mL) and total sugar (20.84%). In general, combine application of NPK (T8) were the most effective in enhancing fruiting aspects, yield, physiochemical characteristics as well as improved fruit quality of mango trees.

O experimento foi realizado em manga cv. Dusehri para investigar o efeito dos fertilizantes N, P e K no crescimento vegetativo, reprodutivo, produtividade e de qualidade do fruto. Foram utilizadas oito combinações diferentes de fertilizantes: T1 (controle), T2 (N), T3 (P), T4 (K), T5 (NP), T6 (NK), T7 (PK) e T8 (NPK). Cada tratamento de N(1.000 g), P (750 g) e K (750 g) foi aplicado duas vezes durante a estação de crescimento em fevereiro e agosto. Todos os tratamentos influenciaram significativamente o crescimento vegetativo, floração, frutificação, produtividade e outros atributos físico-químicos da manga em relação ao controle. Menos efeito foi observado com a aplicação individual de fertilizante, enquanto os tratamentos combinados aumentaram a maioria dos parâmetros investigados. Especialmente as características qualitativas mostraram diferenças não significativas entre mangueiras tratadas e não tratadas. No entanto, entre os diferentes tratamentos, T8 (NPK) apresentou significância para aspectos de frutificação, como tamanho máximo de folgas de crescimento (177,51 mm), número total de panículas/árvore (845), número total de flores/panícula (974), razão sexual (69,18%), retenção de frutos (13,85%), número total de frutos/árvore (379), produção (82 kg/árvore), peso do fruto (197,5 g) e peso da polpa (135,5 g), além de parâmetros físico-químicos, como TSS (24,53), vitamina C (57,63 mg/100 mL) e açúcar total (20,84%). Em geral, a aplicação combinada de NPK (T8) foi a mais eficaz no aprimoramento dos aspectos de frutificação, produtividade, características físico-químicas, além da melhoria da qualidade dos frutos das mangueiras.

Effects of different combinations of N, P and K at different time interval on vegetative, reproductive, yield and quality traits of mango (Mangifera Indica. L) cv. Dusehri

Abstract The experiment was carried out on mango cv. Dusehri to investigate the effect of N, P and K fertilizers on vegetative, reproductive growth, yield and fruit quality. Eight different fertilizer combinations such as T1 (control), T2 (N), T3 (P), T4 (K), T5 (NP), T6 (NK), T7 (PK) and T8 (NPK) were used. Individual or combine fertilizer application of N (1000 g), P (750 g) and K (750 g) were applied during growing season in February and August. All the treatments significantly influenced on vegetative growth, flowering, fruiting, yield and other physiochemical attributes of mango as compared to control. Least effect was observed with individual fertilizer application while combine fertilizer treatments enhanced most of the investigated parameters. Especially, qualitative traits showed non-significant differences between treated and untreated mango trees. However, among the different treatments T8 (NPK) showed significance for fruiting aspects such as maximum size of growth flushes (177.51 mm), total number of panicles/tree (845), total number of flowers/panicle (974), sex ratio (69.18%), fruit retention (13.85%), total number of fruits/tree (379), yield (82 kg/tree), fruit weight (197.5 g), pulp weight (135.5 g) and physiochemical parameters namely TSS (24.53), Vit. C (57.63 mg/100 mL) and total sugar (20.84%). In general, combine application of NPK (T8) were the most effective in enhancing fruiting aspects, yield, physiochemical characteristics as well as improved fruit quality of mango trees.

Resumo O experimento foi realizado em manga cv. Dusehri para investigar o efeito dos fertilizantes N, P e K no crescimento vegetativo, reprodutivo, produtividade e de qualidade do fruto. Foram utilizadas oito combinações diferentes de fertilizantes: T1 (controle), T2 (N), T3 (P), T4 (K), T5 (NP), T6 (NK), T7 (PK) e T8 (NPK). Cada tratamento de N (1.000 g), P (750 g) e K (750 g) foi aplicado duas vezes durante a estação de crescimento em fevereiro e agosto. Todos os tratamentos influenciaram significativamente o crescimento vegetativo, floração, frutificação, produtividade e outros atributos físico-químicos da manga em relação ao controle. Menos efeito foi observado com a aplicação individual de fertilizante, enquanto os tratamentos combinados aumentaram a maioria dos parâmetros investigados. Especialmente as características qualitativas mostraram diferenças não significativas entre mangueiras tratadas e não tratadas. No entanto, entre os diferentes tratamentos, T8 (NPK) apresentou significância para aspectos de frutificação, como tamanho máximo de folgas de crescimento (177,51 mm), número total de panículas/árvore (845), número total de flores/panícula (974), razão sexual (69,18%), retenção de frutos (13,85%), número total de frutos/árvore (379), produção (82 kg/árvore), peso do fruto (197,5 g) e peso da polpa (135,5 g), além de parâmetros físico-químicos, como TSS (24,53), vitamina C (57,63 mg/100 mL) e açúcar total (20,84%). Em geral, a aplicação combinada de NPK (T8) foi a mais eficaz no aprimoramento dos aspectos de frutificação, produtividade, características físico-químicas, além da melhoria da qualidade dos frutos das mangueiras.

Knowledge of Stroke and its Risk Factors among Stroke Survivors: A Hospital Based Study.

Significant variations observed in stroke incidence, risk factors and sufferings between high & resource poor countries. Considering lack of study in our country perspective, the study was designed to assess the knowledge of stroke and its risk factors among stroke survivors in Bangladeshi population. This hospital based cross-sectional study was conducted at the Department of Medicine and Department of Neurology in Uttara Adhunik Medical College & Hospital (UAMCH), Dhaka, Bangladesh. Patients aged >18 years who were admitted with stroke (Ischemic and hemorrhagic) were included in the study. Before enrollment informed consent was ensured. Total 50 patients were interviewed and assessed. Separate case record form was used during data collection. Final analysis was done by SPSS 22.00 version software. A 'good' knowledge of stroke was defined by correct answer to ≥4 out of 7 questions about location, cause, risk factor, warning sign, treatment, complication and prevention of stroke. Among 50 stroke survivors, mean age was 58.34±12.90 (SD) years. Male-female ratio was 1.08:1. Overall 78% patients had good knowledge of stroke. Brain was correctly identified as center of stroke by 52% stroke survivors and disturbance of blood supply to brain as a cause of stroke was recognized by 12%. Stress was the most common risk factor identified (50%). At least one warning sign was identified by 76% stroke survivors. Seventy-four percent stroke survivors knew that they have to be taken to nearest health facility and if possible, in hospital where neurological care is available. Only 4% knew about the golden hour of taking the stroke patient. On average knowledge about treatment, complication and prevention of stroke was good. Stroke knowledge was not significantly associated with demographic and socio-economic profile of stroke survivors. More than two thirds of the patients had knowledge regarding stroke and its risk factors but no uniform pattern of knowledge is noticed.

Effects of different combinations of N, P and K at different time interval on vegetative, reproductive, yield and quality traits of mango (Mangifera Indica. L) cv. Dusehri.

The experiment was carried out on mango cv. Dusehri to investigate the effect of N, P and K fertilizers on vegetative, reproductive growth, yield and fruit quality. Eight different fertilizer combinations such as T1 (control), T2 (N), T3 (P), T4 (K), T5 (NP), T6 (NK), T7 (PK) and T8 (NPK) were used. Individual or combine fertilizer application of N (1000 g), P (750 g) and K (750 g) were applied during growing season in February and August. All the treatments significantly influenced on vegetative growth, flowering, fruiting, yield and other physiochemical attributes of mango as compared to control. Least effect was observed with individual fertilizer application while combine fertilizer treatments enhanced most of the investigated parameters. Especially, qualitative traits showed non-significant differences between treated and untreated mango trees. However, among the different treatments T8 (NPK) showed significance for fruiting aspects such as maximum size of growth flushes (177.51 mm), total number of panicles/tree (845), total number of flowers/panicle (974), sex ratio (69.18%), fruit retention (13.85%), total number of fruits/tree (379), yield (82 kg/tree), fruit weight (197.5 g), pulp weight (135.5 g) and physiochemical parameters namely TSS (24.53), Vit. C (57.63 mg/100 mL) and total sugar (20.84%). In general, combine application of NPK (T8) were the most effective in enhancing fruiting aspects, yield, physiochemical characteristics as well as improved fruit quality of mango trees.

Mental Health of the COVID-19 Patients in Bangladesh.

The mental health aspect of coronavirus disease-19 (COVID-19) patients in Bangladesh has remained less focused and has not been addressed properly. The objective of the study was to assess the levels of anxiety and depression in COVID-19 patients. We adopted a mixed online and telephone-based survey using Google Forms. Recruitment was performed through a snowball sampling approach. The Google Form was initially circulated in Facebook to identify interested participants. Then, three trained physicians interviewed the online responders over telephone for a period spanning from April 2020 to June 2020. Two well-known questionnaires, the Generalized Anxiety Disorder 7-item (GAD-7) scale and the Patient Health Questionnaire (PHQ-9), were used for the assessment of anxiety and depression, respectively. Here, the severity of anxiety was classified with the standard thresholds: minimal or none (0-4), mild (5-9), moderate (10-14) and severe (>15) for the GAD-7. Depression severity score: 0-4 was considered as none or no depression, 5-9: mild, 10-14: moderate, 15-19: moderately severe, 20-27 was for severe depression. A total of 237 patients were finally analyzed. The mean age ±SD of the patients was 41.59±13.73 years. Most of them were male (73%) and lived in urban areas (90.29%). Half of the patients were unemployed, and 17.7% admitted loss of job due to lockdown. The overall prevalence of anxiety and depression was 55.7% and 87.3%, respectively. The mean GAD-7 score was 5.79±4.95, and the mean PHQ-9 score was 5.64±5.15. Among the depressive patients, 3% had minimal depression, 38.4% had mild depression, 32.1% had moderate depression, 11.8% had moderate depression, and 2.1% had a severe depression. Similarly, 37.1%, 10.5% and 8% had mild, moderate and severe levels of anxiety, respectively. Nearly half of the study population (47.7%) was suffering from both depression and anxiety. Living in urban area was an independent predictor for depression (OR 3.882; CI: 1.249-12.069). Considering the high comorbid burden, the mental health issues of these patients need to be addressed and reinforced to the existing health system on a priority basis.

Laparoscopic Adrenalectomy: Two Years Experience at Bangabandhu Sheikh Mujib Medical University.

Laparoscopic surgery has become an efficient tool for many complex surgical procedures. In last decades, laparoscopic adrenalectomy has become a more viable option for removal of adrenal pathology, with many surgeons preferring it to the conventional open technique. This study was done to evaluate the outcomes of lateral transperitoneal adrenalectomy (LTA) in our department and evaluate the feasibility of lateral transperitoneal adrenalectomy (LTA) in our perspective. This study is case series observational study carried out at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2015 to May 2017. Suspected primary adrenal malignancies were excluded. Seventeen (17) patients (10 male and 7 females with mean age of 35.29 years) underwent 18 adrenalectomy (one bilateral). Seventeen (17) adrenal tumours were resected through laparoscopy and one adrenal tumour is resected through open approach due to conversion. All the patients underwent hormonal evaluation, ultrasonogram and computed tomography of whole abdomen. Ten (10) patients (58.82%) had hormonal active adrenal mass. Seven (7) patients (41.18%) were asymptomatic of which 2 had associated cholelithiasis, 7 patients had generalized weakness, 3 had weight gain with Cushing syndrome (one drug induced) and one had Hirsutism with musculanizing effect. Nine (9) patients had hypertension and 6 patients had diabetes mellitus. Eight (8) right, 8 left and 1 bilateral LTA were performed. The mean age of the patients were 35.29 years, adrenal tumour size ranges from 15-65mm and operation time ranges from 75-120 minutes for unilateral adrenalectomies and 220 minutes for bilateral adrenalectomy. Estimated blood loss ranges from 30 to 130 ml in 16 cases and in one case it was 220 ml in which conversion was done. Mean post operative stay in hospital was 3.94 days. In 16 cases no major or minor complications were observed but in one case due to haemorrhage and infiltration of the tumour to kidney conversion are done in the form of right adrenalectomy with upper partial nephrectomy (Histopathology revealed angiomyolipoma). In pathological examination 9 patients (52.94%) had adrenocortical adenoma, 2 patients (11.76%) had phaeochromocytoma including bilateral one, 2 patients (11.76%) had myolipoma of which one converted to open, 2 patients (11.76%) had adrenocortical hyperplasia, one patient (5.88%) had adrenal cyst and one patient (5.88%) had haemorrhagic cyst. LTA is a safe and efficient minimally invasive treatment options for both secreting and non secreting adrenal masses. The procedure has a learning curve and should be performed by a surgeon experienced in both open and laparoscopic adrenal surgery.

Porcelain Gallbladder: A Case Report.

"Porcelain gallbladder" term has been used to highlight the blue staining and fragile consistency of the gallbladder wall at surgery. Some authorities avoid these terms and alternately call all calcified gallbladders "porcelain gallbladders". It is a morphological deviation of chronic cholecystitis. Inflammatory scarring of the wall combined with dystrophic calcification inside the wall transforms the gallbladder into a porcelain-like container. In porcelain gallbladder patients are usually asymptomatic and the condition is usually noted incidentally on plain abdominal radiographs, sonograms, or computed tomography (CT) images. Porcelain gallbladder is a rare condition; recognizing the clinical and imaging characteristics of the disease is important because of the high frequency (22%) of adenocarcinoma in porcelain gallbladder. Operation should not be delayed even if the patient is asymptomatic, because the incidence of carcinoma in porcelain gallbladder is extremely high. Here we present a case of 45 years old lady with porcelain gallbladder who was initially diagnosed as a case of carcinoma gallbladder at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 5th August 2017. But she was found to have a benign gallbladder after cholecystectomy.

Nodular Mucinosis of Male Breast: A Rare Case Report.

Multinodular accumulation of stromal mucin in breast known as nodular mucinosis is an extremely rare condition of breast. Alternatively it is known as myxoma or nerve sheath myxoma of breast. This benign lesion is confined to only nipple and areola region presenting as slow growing, soft and non tender lobulated mass. Histopathologically it reveals well circumscribed non-encapsulated myxoid/mucinous lesion with few infiltration of spindle cells within a collaginized stroma. The mucinous substance is stained positively with Alcian blue. Mucinous carcinoma or phylloids tumour are important differential diagnosis of nodular mucinosis of breast. Here we report a case of nodular mucinosis of male breast with clinical, radiological and pathological findings with differential diagnosis and treatment modalities.

Prevalence of Salmonella species in broilers during slaughtering by processing plants in Trinidad using three isolation methods

Objective: To determine the prevalence of Salmonella species during slaughtering and dressing of broiler chickens at four poultry processing plants in Trinidad using three isolation methods. Design and Methodology: In this cross-sectional study, a total of 396 samples were collected from all four commercial poultry processing plants in Trinidad. Samples collected comprised swabs of cloacae pre-slaughter, pre evisceration and post evisceration carcasses; immersion chiller water, neck skins, whole carcasses and chicken parts (final product). Isolation and identification of Salmonella spp. were performed using standard bacteriological techniques (whole carcass enrichment, whole carcass rinse and neck skin methods). Results: The overall prevalence of Salmonella spp. was 27.5% (109/396). The prevalence of Salmonella spp. was 2.2% (2/90), 55.6% (25/45), 37.8% (17/45), 27.8% (25/90), 5.6% (2/36), 44.4% (20/45) and 40.0% (18/45) for cloacal swabs, preevisceration carcasses, post evisceration carcass swabs, neck skins, immersion chiller water, whole carcass and chicken parts respectively (p<0.001). Salmonella was isolated from 52.3% (46/88), 19.3% (34/176), 11.4% (5/44) and 27.3% (24/88) of the samples from Plant A, B, C and D respectively (p<0.001). Overall, Salmonella was detected in 27.2% (49/180), 27.8% (25/90) and 39.4% (71/180) carcasses by whole carcass rinse, neck skin method and whole carcass enrichment method respectively (p= 0.028). Conclusion: Data from the study indicate the extent of contamination by Salmonella spp. throughout the various stages of broiler processing at the four plants studied and, of significance is the risk of salmonellosis posed to consumers of contaminated, undercooked chicken sold to retail outlets by these processing plants in the country.

Bt Eggplant Project in Bangladesh: History, Present Status, and Future Direction.

The purpose of this article is to provide information on the history, accomplishments, and future direction of the Bt brinjal (eggplant) program in Bangladesh, formerly under the Agricultural Biotechnology Support Project II, now the South Asia Eggplant Improvement Partnership (SAEIP). The India-based Maharashtra Hybrid Seed Company (Mahyco) developed an eggplant expressing Cry1Ac (EE-1) for control of the eggplant fruit and shoot borer (EFSB). In a partnership among Mahyco, USAID, Sathguru Management Consultants and Cornell University EE-1 was provided to the Bangladesh Agricultural Research Institute (BARI) who bred it into local varieties. After regulatory approval, four varieties were distributed to 20 farmers who harvested Bt brinjal in 2014. Adoption in subsequent years has increased rapidly so that, in 2018, 27,012 farmers used this technology. This article provides background information on the process leading up to current adoption levels, the level of control of EFSB achieved and the economic benefits of Bt brinjal. Efforts on stewardship, farmer training and communication are discussed. In order to ensure the long-term future of the partnership, we discuss the need to enhance involvement of the private sector in the production and stewardship of Bt eggplant. Bt brinjal is the first genetically engineered crop to be commercially released in Bangladesh, and other GE crops are in the pipeline. Hence, success of the Bt brinjal partnership is likely to affect the future of other GE crops in Bangladesh, as well as other parts of the world where biotechnology is needed for food security and environmental safety.

Pyrazinamide-resistant mycobacterium tuberculosis isolates from Khyber Pakhtunkhwa and rpsA mutations.

Pyrazinamide (PZA) is a key first-line antibiotic used for the short-course treatment of drug-sensitive and multidrug-resistant (MDR) isolates of tuberculosis. PZA exhibits potent action against semi-dormant bacilli in acidic environments. However, mutations that occur in target genes may cause technical difficulties in the diagnosis of PZA resistance during drug susceptibility testing. The objective of the current study is to identify mutations in pncAWT rpsA and rpsAWT panD genes among PZA-resistant isolates of Mycobacterium tuberculosis (MTB) circulating in the Pashtun dominant region, Khyber Pakhtunkhwa, Pakistan. We selected 18 PZA-resistant pncAWT strains from the Provincial Tuberculosis Reference Laboratory (PTRL) Khyber Pakhtunkhwa to investigate mutations in the coding region of rpsA and panD genes. The experiments were repeated for drug susceptibility testing using MGIT 960 automated system. In addition, eighteen PZA-resistant rpsA genes along with 5 susceptible strains and one H37Rv strain were sequenced. All 18 isolates were PZA-resistant. The majority of these isolates exhibited multidrug resistance (MDR) (13/18). We identified 14 non-synonymous and one synonymous mutation in the coding region of rpsA in 11 strains. All mutations were scattered throughout the gene and not reported previously. Further, we did not identify any mutation in 7 rpsAWT panD genes. Mutations in rpsA but not in panD occur in PZA-resistant pncAWT MTB isolates circulating in Khyber Pakhtunkhwa, Pakistan.