Clinical and radio-angiographic features of paediatric moyamoya disease in Bangladesh

Background: Moyamoya disease is a cerebrovascular arteriopathy of unknown origin characterized by progressive stenosis followed by occlusion of the cerebral arteries. Studies on moyamoya disease, especially in children in Bangladesh, are rare. We aimed to determine the clinical and neuroimaging features of moyamoya disease, particularly angiographic features. Methods: Forty children diagnosed with moyamoya disease were consecutively recruited from Bangabandhu Sheikh Mujib Medical University Hospital, Dhaka, Bangladesh. Each patient underwent a medical history and physical examination focusing on stroke, magnetic resonance imaging, and magnetic resonance angiography scans of the brain. In some instances, electroencephalogram and digital subtraction angiography were also performed. Results: Of the 40 patients, 22 experienced their first-ever stroke (median age, 84 months), and 18 had recurrent strokes (median age, 90 months). Common symptoms included hemiparesis, headache, seizure, and speech disorder. The commonly affected vessels were the internal carotid and middle cerebral arteries. Cortical involvement was found in 82.5% of cases. Bilateral involvement was observed in 37.5% of the patients, most of whom were in the Suzuki stage III. Conclusion: Hemiparesis, headache, seizure, and speech disorder were the common manifestations. Most patients reported late (Suzuki stages III and IV), indicating an advanced stage.  Early detection is necessary, considering the severity of the disease and its inherent tendency for recurrence.  

Surgical versus non-surgical intervention in endometriosis with infertility: a patient preference trial

Background: Hormonal suppression decrease pain and reduce endometrioma size in women with endometriosis. There are medications like cabergoline which reduce inflammation associated with endometriosis but do not prevent ovulation. Hormonal suppression followed by cabergoline may allow pregnancy in women with endometriosis. The objective of the study was to assess and compare the efficacy of medical versus surgical management in infertile women with endometriosis. Methods: A patient preference clinical trial was carried out on 20 women who wish pregnancy and has sonographic evidence of endometrioma and pain. They were counseled adequately about the advantages and disadvantages of surgical and medical management of endometriosis with infertility and were asked to make a choice. The interventions were applied according to patient preference. The interventions were i) dienogest for 3 months when cyst size ≤5 cm and letrozole plus norethisterone for 6 months when cyst size > 5 cm followed by cabergoline 0.5 mg twice weekly for 6 months, plus timed intercourse and ii) laparoscopic surgery followed by expectant management or ovarian stimulation with or without intrauterine insemination. The women were followed up for results. Results: A total of 18 participants opted for medical management and only 2 participants for surgery. All participants given medical management had reduction of pain, and all except one had reduction of cyst size. Pregnancy occurred in 2 out of 14 (14.3%) participants given medication. One woman with surgery had persistence of pain and recurrence of cyst. No one having surgery got pregnant during the study period. Conclusions: The infertile women with endometriosis prefer medical management over surgery. The medical management may be a better option for infertile women with endometriosis who do not plan in vitro fertilization in near future

Communication Between Health Care Providers and At-Risk Mothers: Perceptions and Practices

Background This study examined knowledge, attitudes and opinions regarding alcohol, tobacco, and other drug (ATOD) use during pregnancy among women enrolled in drug treatment centers. It also assessed the educational and screening practices of health care professionals who care for women of child-bearing age in Utah. Methods The assessment of ATOD use was based on a convenience sample of women who were enrolled in drug treatment centers in Utah. The sample (n = 60) was surveyed by trained research team members. The assessment of screening practices of physicians and other medical professionals (n = 350) who deal with women’s obstetric and gynecological conditions was conducted via an online survey. An in-depth interview with seven of the professionals was also conducted. Results Most women surveyed (72%) reported that they would follow the advice of their health care provider regarding the use of alcohol, tobacco and other drugs (ATOD). Other sources of information (e.g. TV, Internet and radio) were less trusted. The women also indicated that a major barrier to disclosing an ATOD use was fear of negative consequences, both legal and social. Analysis of data from the professionals surveyed indicated that while most do some screening, there is a significant difference in ATOD screening practices for pregnant women and for women who are of childbearing age but not pregnant. Further, while nearly all professionals reported educating women who came to their clinic, fewer than 35% indicated using written educational materials. Lack of time was indicated as the primary barrier to proper screening and education of women in health care clinics. Conclusion Women who have been enrolled in treatment centers for ATOD addictions are fearful of the negative legal and social repercussions as a result of their ATOD use and hence do not consistently seek prenatal care. However, when information is given, most women are willing to comply with the recommendations of their health care providers. Providers are also very interested in quality patient care, but indicate that lack of time does not allow adequate one-on-one time with each patient. Screening and educational practices are performed in most offices, but both the timing of the screening and approach to patient education may not be sufficient to ensure optimal outcomes

Investigation of the chemical profiles of seven wood species for their potential applications

Determination of the chemical composition of biomaterial is important for their valued utilization in biorefinery. In this study, the chemical composition of seven wood species, i.e. lambu (Khaya anthotheca), raj-koroi (Albizia richardiana), jhau (Casuarina equisetifolia), sil-koroi (Albizia procera), katbadam (Terminalia catappa), jolpai (Elaeocarpus robustus), and arjun (Terminalia arjuna) were examined. The chemical characterization of these wood species can expedite a further study on the extraction of cellulose, lignin, and extractive. alpha-cellulose content was in the range of 37.0% to 42.1% and lignin content was 20.4% to 34.1%. The solubility in 1% caustic soda was 16.1% to 24.3%. The a-cellulose and lignin content were similar to other wood species. Therefore, these species can be a potential source of raw material for biorefinery

Investigation of the potentiality of five bamboo species in biorefinery through analysis of chemical profiles

Determination of the chemical composition of biomaterial is important for their valued utilization in biorefinery. In this study, the chemical composition of five bamboo species, i.e., mitinga (Bambusa tulda), borak (Bambusa balcooa), rengoon (Thyrsostachys oliveri), orah (Dendrocalamus longispathus), and bajja (Bambusa vulgaris) were determined. The chemical characterization of these bamboo species can expedite a further study on the extraction of cellulose and lignin. alpha-cellulose content was in the range of 42.7-45.7% and Klason lignin content was 22.4-28.2%. The ash content was 1.8-4.3% for the studied five bamboo species. The alpha-cellulose and lignin content were similar to other non-timber spices. The ash content was lower than other non-timber species. Therefore, these species can be a potential source of raw material for biorefinery

Abemaciclib in Combination with Single-Agent Options in Patients with Stage IV Non–Small Cell Lung Cancer: A Phase Ib Study

Purpose: Abemaciclib, a dual inhibitor of cyclin-dependent kinases 4 and 6, has demonstrated preclinical activity in non–small cell lung cancer (NSCLC). A multicenter, nonrandomized, open-label phase Ib study was conducted to test safety, MTD, pharmacokinetics, and preliminary antitumor activity of abemaciclib in combination with other therapies for treatment in patients with metastatic NSCLC. Patients and Methods: An initial dose escalation phase was used to determine the MTD of twice-daily oral abemaciclib (150, 200 mg) plus pemetrexed, gemcitabine, or ramucirumab, followed by an expansion phase for each drug combination. Pemetrexed and gemcitabine were administered according to label. The abemaciclib plus ramucirumab study examined two dosing schedules. Results: The three study parts enrolled 86 patients; all received ≥1 dose of combination therapy. Across arms, the most common treatment-emergent adverse events were fatigue, diarrhea, neutropenia, decreased appetite, and nausea. The trial did not identify an abemaciclib MTD for the combination with pemetrexed or gemcitabine but did so for the combination of abemaciclib with days 1 and 8 ramucirumab (8 mg/kg). Plasma sample analysis showed that abemaciclib did not influence the pharmacokinetics of the combination agents and the combination agents did not affect abemaciclib exposure. The disease control rate was 57% for patients treated with abemaciclib–pemetrexed, 25% for abemaciclib–gemcitabine, and 54% for abemaciclib–ramucirumab. Median progression-free survival was 5.55, 1.58, and 4.83 months, respectively. Conclusions: Abemaciclib demonstrated an acceptable safety profile when dosed on a continuous twice-daily schedule in combination with pemetrexed, gemcitabine, or ramucirumab. Abemaciclib exposures remained consistent with those observed in single-agent studies

Zinc supplementation in male infertility

Background: Inferile males have been shown to have lower levels of seminal plasma zinc which have been associated with reduced levels of zinc in their blood. Supplementation improve semen parameters by improving zinc level in blood.  Objective: To fnd out whether zinc supplementation is effective in improving semen parameters in oligo­asthenozoospermic patients. Method: The study was carried out in the Infertility unit of the Dept of Obs & Gynae, BSMMU during the period of March 2011 to February 2012. Seventy five oligo-asthenozoospermic patients having no history of medical treatment were recruited for the study. The patients were divided into two groups by odd and even numbers. Odd numbers received tablet zinc 20 mg twice daily (Group A) and even numbers received placebo (Group B).Serum zinc level and seminal zinc level estimation were done by Graphite Furnace Atomic Absorption Spectropho­tometry and semen analysis was done according to WHO guidelines (1999). Data analysis was done using software SPSS (version 16) by applying ANOVA (PostHock) and Paired Student's 't' test. Results: Serum zinc level was low in oligo­zoospermic patients which showed significant improvement with zinc supplementation (A+ 197.83 mmol/1, P<0.01). Mean (±SD) seminal plasma zinc level showed significant improvement in group A following zinc supplementation (+942.39 mmol/L, P<0.001). The mean increase in sperm count, sperm motility, sperm rapid linear motility, sperm morphology in group A following zinc supplementation for 12 weeks was 14.83 million/ml (P<0.01), 16.30% (P<0.01), 11.96% (P<0.01), 4.26% (P<0.001) respectively, which was statistically significant. Conclusion: The study shows zinc deficiency affects sperm count, sperm motility, rapid linear motility and sperm morphology and with zinc supplementa­tion there can be significant improvement in semen parameters

Grey, blue, and green hydrogen: A comprehensive review of production methods and prospects for zero-emission energy

Energy is the linchpin for economic development despite its generation deficit worldwide. Hydrogen can be used as an alternative energy source to meet the requirement that it emits zero to near-zero impurities and is safe for the environment and humans. Because of growing greenhouse gas emissions and the fast-expanding usage of renewable energy sources in power production in recent years, interest in hydrogen is resurging. Hydrogen may be utilized as a renewable energy storage, stabilizing the entire power system and assisting in the decarbonization of the power system, particularly in the industrial and transportation sectors. The main goal of this study is to describe several methods of producing hydrogen based on the principal energy sources utilized. Moreover, the financial and ecological outcomes of three key hydrogen colors (gray, blue, and green) are discussed. Hydrogen’s future prosperity is heavily reliant on technology advancement and cost reductions, along with future objectives and related legislation. This research might be improved by developing new hydrogen production methods, novel hydrogen storage systems, infrastructure, and carbon-free hydrogen generation

Opportunities and challenges in the use of coal fly ash for soil improvements – a review

Coal fly ash (CFA), a by-product of coal combustion has been regarded as a problematic solid waste, mainly due to its potentially toxic trace elements, PTEs (e.g. Cd, Cr, Ni, Pb) and organic compounds (e.g. PCBs, PAHs) content. However, CFA is a useful source of essential plant nutrients (e.g. Ca, Mg, K, P, S, B, Fe, Cu and Zn). Uncontrolled land disposal of CFA is likely to cause undesirable changes in soil conditions, including contamination with PTEs, PAHs and PCBs. Prudent CFA land application offers considerable opportunities, particularly for nutrient supplementation, pH correction and ameliorating soil physical conditions (soil compaction, water retention and drainage). Since CFA contains little or no N and organic carbon, and CFA-borne P is not readily plant available, a mixture of CFA and manure or sewage sludge (SS) is better suited than CFA alone. Additionally, land application of such a mixture can mitigate the mobility of SS-borne PTEs, which is known to increase following cessation of SS application. Research analysis further shows that application of alkaline CFA with or without other amendments can help remediate at least marginally metal contaminated soils by immobilisation of mobile metal forms. CFA land application with SS or other source of organic carbon, N and P can help effectively reclaim/restore mining-affected lands. Given the variability in the nature and composition of CFA (pH, macro- and micro-nutrients) and that of soil (pH, texture and fertility), the choice of CFA (acidic or alkaline and its application rate) needs to consider the properties and problems of the soil. CFA can also be used as a low cost sorbent for the removal of organic and inorganic contaminants from wastewater streams; the disposal of spent CFA however can pose further challenges. Problems in CFA use as a soil amendment occur when it results in undesirable change in soil pH, imbalance in nutrient supply, boron toxicity in plants, excess supply of sulphate and PTEs. These problems, however, are usually associated with excess or inappropriate CFA applications. The levels of PAHs and PCBs in CFA are generally low; their effects on soil biota, uptake by plants and soil persistence, however, need to be assessed. In spite of this, co-application of CFA with manure or SS to land enhances its effectiveness in soil improvements