A clinical study of deviated nasal septum with special reference to conventional and endoscopic septoplasty

Background: Deviated nasal septum is a very common condition. It causes nasal obstruction, epistaxis, sinusitis, headache and obstructive sleep apnea. Septoplasty is one of the most common procedures performed for correction of deviated nasal septum. The aim of our study was to determine the incidence of DNS with respect to age, sex, type of septal deviation and presenting complaints and compare if endoscopic septoplasty is better than conventional septoplasty.Methods: The present study was conducted among 115 cases of DNS for a period of one year. While detailed clinical study was done in 115 cases, surgery was performed in 60 cases. They were divided into group A and group B with 30 cases in each group. Conventional septoplasty was performed in group A while endoscopic septoplasty in group B.Results: The male to female ratio was found to be 2.19:1. Majority (37.18%) patients were of age group 11-20 years with deviation to the left (54.78%). Nasal obstruction (58.26%) was the commonest presenting complaint. Postoperatively, a significant relief of symptoms were observed in endoscopic septoplasty in terms of nasal obstruction (93.33%) and hyposmia (87.5%). Post-operative complications were higher in conventional septoplasty with significant rate of residual deviation.Conclusions: Our study showed that functional outcome was better and post-operative complications were less in endoscopic septoplasty. Endoscopic septoplasty provides better illumination which helps to identify septal deviation accurately while reducing the postoperative complications due to limited dissection and lesser trauma to septal cartilage.

The business graduate employability in Bangladesh: dilemma and expected skills by corporate world

Unemployment scenario of the graduate level in Bangladesh has been a serious problem. Lately, graduates are more prone to acquire business education, which is more transferable to the job. Despite that, the business graduates are frustrated with the burden of education, as there are concurrent occurrences of joblessness. However, the prevalent dilemma of employability appears, as there are imbalances due to expected skills/qualifications by the ultimate employers. Analysis of this study tries to indicate this phenomenon by focusing of the skills/qualification (apart from degree, certificate, and diploma) that are considered as important for graduates' employability by the corporate bodies of Bangladesh. Continuous persuasion of immaculate academic results by the business graduates have been identified as less important, whereas more emphasis have been imparted on exposure to the corporate culture and analytical competence. Failure to meet those expected skills would aggravate the situations for graduates' employability

Tapped Twice: A Case of a Rapidly Re-accumulating Hepatic Hydrothorax in a Patient with Spontaneous Bacterial Empyema

Hepatic hydrothorax (HH) is a complication of decompensated liver cirrhosis that only occurs in about 5–6% of cirrhosis patients, defined as a pleural fluid in the setting of known liver disease, with the absence of any other cardiopulmonary etiology. Infected HH is a rare complication, designated as spontaneous bacterial empyema (SBEM), found in only 13–16% of patients with HH. This case follows a patient with SBEM who developed a recurrent pleural effusion minutes after thoracentesis. Our patient is a 56-year-old female with a history of alcoholic cirrhosis with pleuritic pain found to have right-sided pleural effusion with decompensation. She had no ascites. She was initiated on antibiotics due to leukocytosis and underwent thoracentesis, revealing a sterile but exudative pleural effusion with high neutrophil count, confirming the diagnosis of SBEM. Despite initial symptom relief, her respiratory symptoms recurred within mere minutes of thoracentesis. Imaging showed reaccumulated right-sided effusion, and repeat thoracentesis showed a transudative effusion, suggesting HH. While she was in our care, we pursued expert consultation with gastroenterology and thoracic surgery; based on our shared clinical decision making, we agreed that definitive intervention with either indwelling catheter or intrapleural surgical options would cause more harm than good to our patient given her decompensated alcoholic cirrhosis. The patient was discharged with instructions for serial thoracentesis and close follow-up with gastroenterology to discuss next steps regarding her advanced and uncontrolled cirrhosis. We refer to this case to discuss HH and its rare complication of SBEM, as well as the management options for patients with these conditions

Enhancement of Solar PV Hosting Capacity in a Remote Industrial Microgrid: A Methodical Techno-Economic Approach

To meet the zero-carbon electricity generation target as part of the sustainable development goals (SDG7), remote industrial microgrids worldwide are considering the uptake of more and more renewable energy resources, especially solar PV systems. Estimating the grid PV hosting capacity plays an essential role in designing and planning such microgrids. PV hosting capacity assessment determines the maximum PV capacity suitable for the grid and the appropriate electrical location for PV placement. This research reveals that conventional static criteria to assess the PV hosting capacity fail to ensure the grid’s operational robustness. It hence demands a reduction in the theoretical hosting capacity estimation to ensure grid compatible post-fault voltage and frequency recovery. Energy storage technologies, particularly fast-responsive batteries, can potentially prevent such undesirable scenarios; nevertheless, careful integration is required to ensure an affordable cost of energy. This study proposes a novel methodical techno-economic approach for an off-grid remote industrial microgrid to enhance the PV hosting capacity by integrating battery energy storage considering grid disturbance and recovery scenarios. The method has been validated in an industrial microgrid with a 2.6 MW peak demand in a ready-made garment (RMG) factory having a distinctive demand pattern and unique constraints in remote Bangladesh. According to the analysis, integrating 2.5 MW of PV capacity and a 1.2 MVA battery bank to offset existing diesel and grid consumption would result in an energy cost of BDT 14.60 per kWh (USD 0.1719 per kWh). For high PV penetration scenarios, the application of this method offers higher system robustness, and the financial analysis indicates that the industries would not only benefit from positive environmental impact but also make an economic profit

Mutational spectrum and phenotypic variability of Duchenne muscular dystrophy and related disorders in a Bangladeshi population

\ua9 2023, The Author(s).Duchenne muscular dystrophy (DMD) is a severe rare neuromuscular disorder caused by mutations in the X-linked dystrophin gene. Several mutations have been identified, yet the full mutational spectrum, and their phenotypic consequences, will require genotyping across different populations. To this end, we undertook the first detailed genotype and phenotype characterization of DMD in the Bangladeshi population. We investigated the rare mutational and phenotypic spectrum of the DMD gene in 36 DMD-suspected Bangladeshi participants using an economically affordable diagnostic strategy involving initial screening for exonic deletions in the DMD gene via multiplex PCR, followed by testing PCR-negative patients for mutations using whole exome sequencing. The deletion mapping identified two critical DMD gene hotspot regions (near proximal and distal ends, spanning exons 8–17 and exons 45–53, respectively) that comprised 95% (21/22) of the deletions for this population cohort. From our exome analysis, we detected two novel pathogenic hemizygous mutations in exons 21 and 42 of the DMD gene, and novel pathogenic recessive and loss of function variants in four additional genes: SGCD, DYSF, COL6A3, and DOK7. Our phenotypic analysis showed that DMD suspected participants presented diverse phenotypes according to the location of the mutation and which gene was impacted. Our study provides ethnicity specific new insights into both clinical and genetic aspects of DMD

Psychiatric Morbidity Among Suicide Attempters Who Needed ICU Intervention

Background: Suicide is a tragic and serious but preventable public health problem all over the world including Bangladesh. Committing suicide has become a burning issue and mortality rate increases especially in young females. Psychiatric evaluation is needed in suicide attempted patients for better management plan to reduce such unnatural mortality, as well as the impairment related to suicidal thought and psychiatric disorders. Objectives: To assess the psychiatric disorders and conditions that needed sufficient clinical attention among the suicide attempters who needed ICU intervention. Methods: This cross-sectional study was carried out in an Intensive Care Unit (ICU) of a private hospital of Dhaka City from July 2008 to December 2008. Total forty four subjects of attempted suicide were included in the study and psychiatric diagnosis was made by using Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV by psychiatrists after initial physical problems subsided. Results: The most common psychiatric diagnosis was Major Depressive Disorder. Female suffered more and among them attention-seeking behaviors were frequent. Thirty-four patients (77.3%) had previous history of psychiatric disorder. Chemicals (like; organophosphorous, kerosene, harpic and other medicine overdose) ingestion was the most frequently used method by the suicide attempters. Conclusion: This study may be helpful for further research regarding suicide attempters and its' association with mental problems. In primary health care setting, the physicians may get a clue to design a system for preventing, early recognition and managing suicidal ideas, thoughts and attempts. Psychiatric consultation should be made mandatory for all patients admitted following attempted suicide. DOI: 10.3329/bsmmuj.v2i2.4761 BSMMU J 2009; 2(2): 73-7

Modified Radical Mastoidectomy: Open Mastoid Cavity versus Cavity Obliteration Using Periosteal Temporofascial Flap - A Comparative Study

Introduction  The surgical treatment of Chronic Otitis Media by modified radical mastoidectomy usually results in an open cavity, with chronic discharge, hearing loss of 30 to 40 dB, frequent visits to OPD for debris removal and none the less dizziness on cold air exposure. One way to deal with these issues effectively is to obliterate the mastoid cavity. In our study we used vascularised periosteo-temporofascial swing flap with medicated bone dust to obliterate the mastoid cavity. Material and Methods In this prospective study, 50 patients who suffered from chronic otitis media, active squamous (cholesteatoma) disease, and underwent modified radical mastoidectomy with tympanoplasty procedure were and split between two equally sized groups. Group 1 had patients with open mastoid cavity and Group 2 had obliteration of mastoid cavity using vascularised periosteo-temporofascial swing flap with medicated bone dust. Patients were followed at  3rd week, 6th week, 3rd month and 6th month. Results  Patients with cavity obliteration had better and statistically significant outcomes in term of discharge status of cavity and epithelization at 3 weeks. Patients with obliteration also had positive and statistically significant results in hearing levels and hearing gain at 6 months follow up. Conclusion  Mastoid cavity obliteration with vascularised periosteo-temporofascial swing flap with medicated bone dust is a good and effective method for better post-operative outcomes and curtailing dependency on doctors for cavity care

Epidemiology and risk factors for pneumonia severity and mortality in Bangladeshi children <5 years of age before 10-valent pneumococcal conjugate vaccine introduction

Abstract Background Pneumonia is the leading infectious cause of morbidity and mortality in young children in Bangladesh. We present the epidemiology of pneumonia in Bangladeshi children <5 years before 10-valent pneumococcal conjugate vaccine introduction and investigate factors associated with disease severity and mortality. Methods Children aged 2–59 months admitted to three Bangladeshi hospitals with pneumonia (i.e., cough or difficulty breathing and age-specific tachypnea without danger signs) or severe pneumonia (i.e., cough or difficulty breathing and ≥1 danger signs) were included. Demographic, clinical, laboratory, and vaccine history data were collected. We assessed associations between characteristics and pneumonia severity and mortality using multivariable logistic regression. Results Among 3639 Bangladeshi children with pneumonia, 61% had severe disease, and 2% died. Factors independently associated with severe pneumonia included ages 2–5 months (adjusted odds ratio [aOR] 1.60 [95% CI: 1.26–2.01]) and 6–11 months (aOR 1.31 [1.10–1.56]) relative to 12–59 months, low weight for age (aOR 1.22 [1.04–1.42]), unsafe drinking water source (aOR 2.00 [1.50–2.69]), higher paternal education (aOR 1.34 [1.15–1.57]), higher maternal education (aOR 0.74 [0.64–0.87]), and being fully vaccinated for age with pentavalent vaccination (aOR 0.64 [0.51–0.82]). Increased risk of pneumonia mortality was associated with age <12 months, low weight for age, unsafe drinking water source, lower paternal education, disease severity, and having ≥1 co-morbid condition. Conclusions Modifiable factors for severe pneumonia and mortality included low weight for age and access to safe drinking water. Improving vaccination status could decrease disease severity

Time trends and sociodemographic determinants of preterm births in pregnancy cohorts in Matlab, Bangladesh, 1990-2014.

INTRODUCTION: Preterm birth is the major cause of under-five mortality. Population-based data on determinants and proportions of children born preterm are limited, especially from low-income countries. This study aimed at assessing time trends and social, reproductive and environmental determinants of preterm births based on a population-based pregnancy cohort over 25 years in rural Bangladesh. METHODS: In this cohort study in Matlab, a rural area in Bangladesh, we used data from the Health and Demographic Surveillance System from 1990 to 2014. Gestational age at birth was based on the reported last menstrual period and verified by ultrasound assessments. Preterm birth proportions were assessed within strata of social and reproductive characteristics, and time series analysis was performed with decomposition for trend and seasonality. We also determined the prevented fractions of preterm birth reduction associated with social and demographic changes during the follow-up period. RESULTS: Analyses were based on 63 063 live births. Preterm birth decreased from 29% (95% CI 28.6 to 30.1) in 1990-1994 to 11% (95% CI 10.5 to 11.6) in 2010-2014. Low education, older age and multi-parity were associated with higher proportions of preterm births across the study period. Preterm births had a marked seasonal variation. A rapid increase in women's educational level and decrease in parity were associated with the decline in preterm births, and 27% of the reduction observed from 1990 to 2014 could be attributed to these educational and reproductive changes. CONCLUSION: The reduction in preterm birth was to a large extent associated with the sociodemographic transition, especially changes in maternal education and parity. The persistent seasonal variation in the proportion of preterm birth may reflect the environmental stressors for pregnant women across the study period. Continued investments in girls' education and family planning programmes may contribute to further reduction of preterm births in Bangladesh