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Background: There have been a wide variety of clinical publications on coronavirus disease 19 (COVID-19) focused on specific biomarkers. Acute-phase reactants, such as C-reactive protein (CRP), ferritin, serum amyloid A (SAA), and procalcitonin, have been identified as sensitive markers of acute COVID-19 illness, even though they are nonspecific markers. Objective: The purpose of this study is to summarize the role of several biomarkers in the stratification of COVID-19 disease severity. Methods: This study followed systematic literature review method. The systematic review followed the review process as it was well developed and planned to reduce biases and eliminate irrelevant and low-quality studies. The steps for implementing a systematic review include correctly formulating the COVID-19 question to answer, developing a protocol based on inclusion and exclusion criteria, performing a detailed and broad literature search and screening the abstracts of the studies identified in the search and subsequently of the selected complete texts. After selecting the study, the next steps were synthesis of the evidence like extract the necessary data into a form designed in the protocol to summarise the included studies, assess the biases of each study, identifying the quality of the available evidence, and develop tables and text that synthesise the evidence. The secondary sources of data for this study included different published topics from national & international journals. Good number of Journal articles was taken regarding “Role of Biomarkers in the Stratification of COVID-19”. Published articles were collected from renowned indexing data source like PubMed, Medline, and Scopus. Etc. Conclusion: Significantly increased white blood cell count, lymphopenia, decreased CD3, CD4, or CD8 T-lymphocyte counts, high neutrophil count, thrombocytopenia, and dramatically elevated inflammatory biomarkers were all linked to severe disease and the probability of developing sepsis as the disease progressed. Progressive decreases with lymphopenia, thrombocytopenia, elevated CRP, procalcitonin, increased liver enzymes, impaired renal function, and coagulation derangements were more common in critically sick patients and were linked to a higher rate of clinical sequelae. In seriously and critically ill patients, elevated interleukin levels and significantly increased SAA were most frequently reported. The neutrophil to lymphocyte ratio, the systemic immune inflammation index, and the COVID-19 Severity Score are all indicators of systemic inflammation that can be used to predict disease severity, outcome, and death.

OBJECTIVE: Various studies have suggested that obstructive sleep apnea (OSA) affects bone metabolism. One of the most significant factors is hypoxia which induces certain transcription factors that stimulate bone osteoclastic activity. It also induces respiratory acidosis and oxidative stress which enhances bone resorption. Leptin and melatonin secretions are regulated by the circadian system which is affected due to sleep fragmentation in OSA. Other comorbidities associated with OSA such as vitamin D deficiency, hypogonadism, obesity, and insulin resistance are indirect mechanisms that affect bone mineral density (BMD). MATERIAL AND METHODS: This is a prospective case–control study. All patients having symptoms of sleep-related breathing disorder (excluding post-menopausal females or patients with known case of osteoporosis or any other clinical illness which is a direct cause of osteoporosis) attending the Sleep Out Patient Department (OPD) were screened for OSA as per the STOPBANG questionnaire scoring system. Participants having score >2 constituted the final study population and were subjected to the polysomnography test. Participants with an apnea-hypopnea index (AHI) > 5 in polysomnography were considered as cases and those with AHI

This study investigates the critical firm-level strengths and weaknesses that explain cross-sectional variations in abnormal stock returns of Hospitality and Tourism (HT) firms during different phases of a crisis. We used the event study and multivariate regression framework for analysing the Indian HT firms’ data around the COVID-19 crisis. While reporting a significant negative influence of COVID-19, we identified the early crisis, market crash and continuation of the crisis periods. Furthermore, we observe that during the early-crisis period, business diversity, financial stability and board diversity improved HT firms’ strength to withstand the risk, while business group affiliation was of little help. During the market crash and continuation of the crisis phase, better capital intensity and financial stability proved helpful. The managers of HT firms can take cues from this study to understand firm-level characteristics that provide resilience to their firms’ value in managing different phases of the crisis. © 2021 Informa UK Limited, trading as Taylor & Francis Group.

In this work, we propose a framework to assess the many cloud services based on the QoS criteria value in fuzzy environment. Here, we uses the Fuzzy-AHP method to define the architecture of overall...

Global software development (GSD) organisations are currently adopting agile frameworks in order to efficiently develop a software product. The main objective of this study is to identify the success factors (SFs), which could possibly have a positive impact on scaling agile practices in a GSD environment and develop their taxonomy based on their prioritisation using the analytic hierarchy process (AHP) approach. This study is conducted in four stages: problem identification and goal of the study (1), identification of SFs and their categorisations (2), validation of the SFs using questionnaire survey (3), and application of AHP to prioritise the SFs and develop the taxonomy of the SFs and their respective categories (4). The results of this study indicated that ‘technology’ is the most significant category as compared to the other categories of the SFs. Similarly, rich technological infrastructure is identified as a most important factor. Based on the findings of this study, authors can conclude that the contribution of this study is not only limited to development of the taxonomy of the SFs, but also their proper prioritisation by introducing AHP approach, which assists software organisations to scale agile methods effectively in the GSD environment.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death worldwide. Indacaterol is a new once daily inhaled bronchodilator, recently approved for the treatment of COPD. Once daily dosing is an important step to improve the adherence and compliance of the patients. Methods: Efficacy and Safety of Indacaterol and Tiotropium in Patients of COPD with Stage-2 and Stage-3 GOLD criteria were compared. Total 119 patients were divided into Indacaterol group and Tiotropium group receiving 150 mcg daily of Indacaterol and 18 mcg daily of Tiotropium in each group respectively. Efficacy treatment was determined by assessment of Pulmonary function test (PFT), Symptom score and SGRQ (St. George’s Respiratory Questionnaires) score at day zero (before therapeutic intervention) and at two weeks of interval till 24 weeks. Results: The treatment with inhaled indacaterol 150 mcg once daily and inhaled tiotropium 18 mcg once daily improved spirometric variable, FEV1, decrease in mean Symptoms score and in mean SGRQ in Grade-2 and Grade-3 COPD patients. Conclusion: Indacaterol (150 mcg/day) is non-inferior to tiotropium (18 mcg /day) in efficacy and safety profile of Grade-2 and Grade-3 patients with COPD.

Background: The number of COVID-19 patients is exponentially increasing worldwide since December, 2019. Management in intensive care units (ICU) has become a major challenge; therefore, time demanding laboratory markers for early recognition of morbid forms is utmost important for timely triaging of patients. Objective: The present study aimed to evaluate the role of haemotological and Coagulation profile in the assessment of disease severity of COVID-19. Methods: The current study is an observational study done prospectively in Armed Forces Institute of Pathology (AFIP) during the period of 28 March 2020 to 15 May 2020. The study subjects were haematological and coagulation profile data of 100 COVID-19 patients grouped in non-ICU and ICU at the baseline and at 4th day of admission in Combined Military Hospital (CMH), Dhaka. All the data were recorded and analyzed by SPSS 20.0 programme. Results: Here subjects with featured of lymphopenia were detected prominently in our COVID-19 ICU patients with a median nadir ALC of 0.9 x109/L. The most common pattern of coagulopathy observed in patients hospitalized with COVID-19 is characterized by elevation in fibrinogen and Ddimer levels, particularly significantly higher in ICU group. Conclusion: The present study is a reflection of significant anomalies in haematological and coagulation parameters during the disease process with COVID-19. J Bangladesh Coll Phys Surg 2020; 38(0): 61-66

Background: Tuberculosis (TB) remains a major global health problem. India accounts for the one-fourth of the global TB burden. For resource-limited countries like India having high burden of TB, smear microscopy is the most commonly used method for microbiological diagnosis. Although culture being highly sensitive and specific method, it is time-consuming. Under Revised National TB Control Program (RNTCP), Ziehl–Neelsen (ZN) stain-based microscopy and light-emitting diode-based fluorescent microscopy (LED-FM) are being recommended. Aim: The present study was done to determine the sensitivity and specificity of ZN stain-based microscopy and FM (LED-FM) keeping solid culture as gold standard. Materials and Methods: A total of 1503 sputum samples were collected from suspected cases of pulmonary TB (new or previously treated). They were processed and subjected to ZN (conventional light microscopy), Auramine-O (AO) staining (LED-FM) and solid culture on Lowenstein–Jensen medium for detection of acid-fast bacilli. Positive smears were graded according to RNTCP guidelines. Results: Sensitivity, specificity, positive predictive value, and negative predictive value of ZN staining technique were 84.93%, 95.74%, 96.50%, and 82.16%, respectively, and that of FM was 95.25%, 91.33%, 93.81%, and 93.31%, respectively. Conclusion: LED-FM being more sensitive, especially in detecting the paucibacillary cases and less time-consuming, has advantage over ZN method. Nation-wide implementation will lead to improved diagnosis, thus better control of TB.

Introduction: An upper respiratory tract infection which can be either due to increased airway bacterial load or emergence of new bacterial strain is the most common cause of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). Other factors responsible for exacerbation include viral infections, pollution and other unidentified pathogens. Aim: To evaluate the local pattern of bacterial and fungal isolates from patients diagnosed with AECOPD and forming an antibiogram of the hospital. Materials and Methods: A total of 200 clinically diagnosed cases of AECOPD of age ≥40 years were included in the study. Sputum sample was obtained from the patients and processed according to standard lab procedures. Statistical analysis was done by using Statistical Package for Social Sciences (SPSS) version-20. The test applied in the current study was modified chi-square used for comparison of proportion to analyse statistical significance for antibiotic sensitivity. The p-value

Nowadays, software organizations are deploying agile methods in the geographically distributed environment to get several benefits i.e. significant return on investment it produces, fast project delivery, and managing the dynamic behavior of the project development. The execution of agile practices in Global Software Development (GSD) is more complex than collocated environment (single site development). The objectives of this study is to explore the factors which positively and negatively impact on scaling program of agile development in the GSD context and propose a framework based on the factors for successful scaling of agile programs in GSD context. This study is carried out in two stages. In the first stage, a Systematic Literature Review (SLR) protocol was adopted to investigate the factors. In the second stage, the SWOT analytical framework was followed to classify the factors into four categories: strengths, weaknesses, opportunities, and threats. In the SWOT framework, the factors in strengths and weaknesses categories represent the internal aspects of the organizations while the opportunities and threats categories indicate the external aspects of organization. The findings of this study reported 24 factors. The identified 13 factors positively and 11 factors negatively impact on scaling program of agile development respectively. Moreover, a framework based on SWOT analysis is proposed that provided the classification of factors into four categories. Based on the research outcomes, we can conclude that the identified factors and their classification into SWOT categories provide a robust framework that will assist the agile practitioners for successfully scale agile development in the GSD organizations.

Pirfenidone has been approved for the treatment of idiopathic pulmonary fibrosis due to its anti-fibrotic activity. It has been shown to have anti-inflammatory and antioxidant properties apart from being an anti-fibrotic agent. Cytokine storm, severe inflammation and oxidative stress leading to acute respiratory distress syndrome and multiorgan failure are factors causing mortality in patients of COVID-19. This article reports two cases of 35 years and 60-year-old male patients of COVID-19, those were diagnosed by real time Polymerase Chain Reaction (PCR) using nasopharyngeal samples. They were started on pirfenidone 400 mg BD, later increased to 600 mg TDS along with empirical antibiotics, dexamethasone, supplemental oxygen and non-invasive ventilator support. Both the patients improved and were discharged. Both the patients were followed by telemedicine after one week, did not require oxygen at rest and were comfortable at rest in contrast to earlier complaints. Thus, the authors conclude that pirfenidone can be a possible cure for COVID-19 patients, larger trials are required to confirm its efficacy.

Pulmonary involvement is common in patients with systemic sclerosis. The most common underlying histology is Non Specific Interstitial Pneumonia (NSIP). Disrupted immunity from the disease or associated medication may render such patients prone to develop tuberculosis infection. A 55-year-old female patient presented with chief complaints of shortness of breath from past five years which was gradually progressive, cough initially dry later with minimal expectoration, low grade fever from past two months. She also gave history of bluish discolouration of fingers tips on exposure to cold water. On examination there was restrictive mouth opening, thickened skin over hands, forearm, face, neck and trunk on pinching. Sclerodactyly was present with clubbing grade 2. On auscultation bilateral fine crepts were present. Serum ANA was highly raised and Scl 70 was positive. PFT was suggestive of restrictive ventilatory abnormality. Sputum smear for AFB was found to be positive. HRCT thorax was suggestive of NSIP. Patient was put on antituberculer treatment under DOTS category 1; nifedipine, pentoxyphylline and nitroglycerine gel was started for raynauds phenomenon. Chemotherapy for systemic sclerosis was given with cyclophosphamide infusion in six cycles every four weeks.

Introduction: Pleural effusions are one of the most common entities encountered by pulmonologists worldwide which have a very long list of causes. Initial workup of these patients begins with a chest X-ray and percutaneous or Ultrasound (USG) guided thoracocentesis followed by biochemical and cytological evaluation of the fluid to ascertain the cause of effusion. A 20 to 25% of cases remain undiagnosed even after thoracocentesis and closed pleural biopsy. Medical Thoracoscopy is emerging as a safe diagnostic procedure in these patients. Aim: To detect the diagnostic yield of medical thoracoscopy in cases of undiagnosed exudative lymphocytic pleural effusion and to study the complications associated with it. Materials and Methods: This was a prospective observational study, carried out in the Department of Pulmonary Medicine, JN Medical College and hospital, Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, India, from August 2016 to August 2018. Undiagnosed exudative pleural effusion was defined as pleural effusion with Adenosine Deaminase (ADA) levels less than 70 IU/L and negative pleural fluid cytology for malignancy. Thoracoscopic examination of the pleural space using flexi-rigid thoracoscopy was done and biopsy was taken from suspected areas and the tissue obtained, was send for histopathological examination. The results were presented as mean±SD (Standard Deviation) or percentage. Differences in categorical data were compared using the chi-square test or the Fisher-exact test. A p-value of

Unilateral hyperlucency of the lung is not an uncommon finding which arises from a variety of conditions, like technical, congenital and acquired. Here, the author presents a case of diaphragmatic hernia which presented as unilateral hyperlucency on chest radiography. A 45-year-old female, presented with complaint of shortness of breath for 2-3 years, increased since 15 days and pain in abdomen for 2-3 years. She consulted a doctor where a chest X-ray was done and was advised Intercostal tube insertion with the diagnosis of left-sided pneumothorax and was referred to us for further management. Instead of her vitals were stable on examination. On auscultation, breath sounds were of decreased intensity. A chest X-ray was then done which showed unilateral hyperlucency of the left side with the presence of air fluid level. The CECT thorax showed a large diaphragmatic hernia through which the large intestine and stomach were occupying the left hemithorax. Therefore, a thorough evaluation should be done before reaching a definitive diagnosis in such patients.

The Indian securities market regulator intervened in June 2010 with a regulatory amendment in the listing requirement that mandated all the listed firms other than PSUs (government‐owned companies) to have a minimum public shareholding of 25%. The affected firms were given a 3‐year window to comply with the regulation. This study examines the impact of the new regulation on the affected firms’ value. We explore the relationship between improvement in firms’ value and stock liquidity. This regulatory intervention offers a natural experiment to examine direct causality between stock liquidity and firms’ value. The findings of the empirical analysis confirm the existence of a direct causal relationship between stock liquidity and firm value, stemming from an improved operating performance.

Introduction: Invasive fungal infections are increasingly common in the nosocomial setting. Materials and Methods: The patients were divided into two groups immunocompetent and immunocompromised that is, patients with significant neutropenia

Multiple large round well circumscribed pulmonary nodules in lungs are known as cannon ball secondaries. There are malignant and non-malignant causes of cannon ball secondaries. In case of malignancy, they represent classical haematogenous dissemination to the lungs of a primary malignant tumor. Secondaries to lung from renal cell carcinoma and choriocarcinoma are necrotic. The less common primary tumors causing cannon ball secondaries to lung includes prostate carcinoma, synovial sarcoma, endometrial carcinoma and some gastrointestinal malignancies. Here we presented a very rare case, maybe first of its kind of multiple cavitating cannon ball secondaries where primary malignancy was in lung itself which was EGFR positive adenocarcinoma lung. This case was also rare as cavitation is largely a feature of squamous cell carcinoma lung both of primary and metastatic lung malignancy.

Global Software Development (GSD) has gained great attention during the past decade or so, and it is also being adopted by most of the software development organizations. The GSD approach is practiced by the software development organizations in China and a wide range of firms have established its operations in various Chinese cities. However, GSD practices becomes more challenging for the projects based on the agile concepts. The aim of this study is to develop a taxonomy of the factors that could positively impact the scaling process of agile methods in the Chinese GSD industry. The factors are identified by exploring the available literature and conducting industrial study with the Chinese agile and GSD practitioners. The finally reported factors are categorized, prioritized and developed their taxonomy using the multi-criterion decision making (MCDM) Fuzzy AHP approach. The given taxonomy is significant and progressive for GSD industry to assess and improve the scaling process of agile methods.

Background: The majority of children with Cerebral Palsy have feeding difficulties. It has a great impact on growth and development in children with cerebral palsy. Feeding difficulties may leads to chronic respiratory disease, malnutrition and reduce quality of life of both children and caregiver. Feeding difficulties cause stressful meal time for caregivers and fear of food for children. In well resource country many hi-tech equipments for the management of feeding difficulties are available but which is not available in low resource country like Bangladesh. Though some of low tech approaches have started a little but the effectiveness or outcomes of these technologies are not evaluated. This study is aimed to evaluate the effect of feeding training on feeding difficulties in children with cerebral palsy.Methods: This is a quasi experimental study. Twenty children with cerebral palsy aged 2 – 9 years having feeding difficulties enrolled as study subjects. Initially degree of feeding difficulties were assessed by evaluating body posture and frequency of aspiration during feeding which is scored according to the response of the child. After giving feeding training to the mother feeding difficulties were reevaluated. Mean score of feeding difficulties before and after intervention were compared by paired 't' test. Results were analyzed by SPSS.Results: Among the study subject 14(70%) were male and 6(30%) were female. Most of them were found to have hemiplegic CP 7(35%). The mean score in terms of positioning and frequency of aspiration were significantly changed after intervention (14.15 vs. 15.85 p =

Background: Acute lymphoblastic leukaemia (ALL) is a common malignancy in children which may cause significant nutritional problem as well as micronutrient deficiency like zinc. These deficiencies ultimately affect the outcome of the patient.Objective: The present study was done to identify the relationship of height, weight and serum zinc with acute lymphocytic leukemia in pediatric patients.Methods: This observational study was carried out in the Department of Pediatric Haematology and Oncology, Dhaka Medical College Hospital, Dhaka over a period of one year from July 2013 to June 2014. All children ranging from 1-10 years with newly diagnosed acute lymphocytic leukaemia were enrolled as case. An equal number of healthy children of similar age and sex were also included as control. The outcome measures were weight for height (wasting) and height for age (stunting) in children 5 or below 5 years of age and BMI in children > 5 years of age. The serum zinc level was also studied as a measure of micronutrient status.Result: Majority (80%) of the cases and 60% of the controls were 5 or < 5 years old. The mean ages of the children of cases and controls were almost similar (4.2 ± 2.3 vs. 4.8 ± 1.8 years, p >0.05). The groups were significantly different in terms of sex with male children being more prone to develop leukaemia than the females (p

With the growing demand and the varied availability of a large number of cloud services, it has become difficult to discover a relevant cloud service that can satisfy cloud customer’s functional needs. From the customer’s point of view, it is hard to decide, which cloud service satisfy their QoS (Quality of Service) requirement and what is the basis for their selection. To assist the cloud customer in the optimal service selection, a framework has been proposed, which allows cloud customer to assess the many cloud service providers by considering the QoS attribute value. In this work, we put forward an improved MCDM (Multi Criteria Decision Making) methodology that improves the existing cloud service selection methods. In particular, we use Best-Worst method for calculating the attribute weights and apply TOPSIS (Technique for Order Preference by Similarity to Ideal Solution) method for calculating the final rank of cloud service provider. Furthermore, we use a real time case study to analyze the pertinence of the proposed technique. The experimental results affirm the feasibility and effectiveness of the proposed methodology. This research helps to create a strong competition among the cloud service providers.

Currently, software organizations are implementing agile methodologies in global software development (GSD) because of low development cost, schedule and high quality product. However, GSD project is complex undertaken because of it distributed dimensions especially when the agile methodologies are concerned. The objective of this study is to identify the human related factors that can negatively influence agile practices in GSD organizations, and proposed a hypothetical model of the identified challenges related to the scaling agile methodologies. A Systematic Literature Review (SLR) method was used to identify the challenges. In the findings, a total of eleven challenges were identified using SLR. This study also reported the Critical Challenges (CChs) for scaling agile methodologies using a criterion of the challenges having a frequency $\ge 50$%. Findings reported the six out of eleven challenges as critical challenges in scaling agile methods. Based on the identified challenges, a hypothetical model was presented that is highlighted a relationship between identified challenges and the implementation of agile methodologies in GSD environment.

Cloud-Based Outsource Software Development (COSD) is a new methodology adopted by organizations to develop software using teams of knowledge workers located across the globe using cloud computing services. However, there is a lack of understanding of challenges associated with successful execution of COSD projects. The objective of this study is to identify and prioritize the challenges that influence COSD projects. First, we conducted a Systematic Literature Review (SLR) and identified 21 challenges that impact COSD projects. Next, a questionnaire survey was developed based on the SLR findings to collect feedback from industry practitioners. Finally, we applied the Fuzzy Analytical Hierarchy Process (FAHP) to rank the identified challenges for COSD projects. We also present a prioritization-based taxonomy of the identified challenges which will help practitioners to focus on the critical areas for successful implementation of COSD projects.

Phrenic nerve palsy causing hemidiaphragm paralysis is a very uncommon feature of thoracic aortic aneurysm. In one case, a 30 year male complained of chronic dull aching chest pain, and hoarseness of voice; posteroanterior view chest radiograph revealed large spherical radiopacity on the left upper lung zone with smooth lobulated margin with elevated left hemidiaphragm. On Colour Doppler sonography, lesion was anechoic on gray scale sonography but on Doppler analysis revealed intense internal vascularity within it with characteristic "Ying Yang" sign. The finding favor the vascular origin of the lesion and a diagnosis of an arterial aneurysm was made Contrast-enhanced computed tomography (CT) of the thorax revealed a large well defined spherical lesion of 8 × 10 cm size with smooth well defined margin arising from the aortic arch and attenuation of impending rupture or dissection were lesion on immediate post contrast and delayed scan was similar to that of aorta. Left hemidiaphragm elevation was explained by the gross mass effect of the aneurysm causing right phrenic nerve palsy.

Increasingly, software development organizations are scaling agile practices in the global software development (GSD) environment in order to meet the requirements of the quickly changing and regularly developing business environment. The main objectives of this study are to investigate the key barriers and develop a prioritization-based taxonomy of the barriers for scaling agile development in the GSD environment. Total twenty-two barriers were extracted from the available literature and categorized into five categories, i.e. “human resources management”, ‘coordination”, “technology”, “project management”, and “software methodology”. In the next phase, the identified barriers and their categories were further validated using the questionnaire survey. In the final phase, fuzzy-AHP method, a multi-criterion decision making (MCDM) technique, was applied to prioritize and taxonomy of identified barriers and their related categories was designed. The contribution of this study is not limited to investigate the barriers, but it also provides the roadmap to tackle the issues related to the scaling agile methods in the GSD environment.

INTRODUCTION: Allergic rhinitis and bronchial asthma are thought to be sequela of the same allergic airway disease. The relationship between both diseases has been confirmed by various clinicopathological epidemiological and immunological studies. In this study, we tried to establish a different relationship between both diseases and strengthen the concept of “One-airway one disease.” MATERIALS AND METHODS: A total of 100 patients visiting ear, nose, and throat and respiratory medicine outpatient department were taken. They were divided into two groups of fifty each and were studied for various mediators of inflammation. Group 1 consisted of patients of allergic rhinitis and Group 2 consisted of patients of bronchial asthma. RESULTS: Most of the patients in Group 1 were in the age group of 21–30 years (40%) and in Group 2, in the age group of 11–20 years (38%) with a mean age 28.4 ± 1.3 years. The most common symptoms in Group 1 patients were sneezing (90%) and rhinorrhea (68%) and in Group 2 wheezing (86%), followed by shortness of breath (66%). The most common sign in Group 1 was B/L inferior turbinate hypertrophy (70%), while in Group 2, it was rhonchi (76%). Mean absolute eosinophil count was 575.35 in Group 1 and was 446.61 in Group 2. Nasal smear for eosinophil was positive for 86% of patients in Group 1 and bronchial lavage showed eosinophilia in 64% of Group 2 patients. Mean total serum immunoglobulin E was 777.23 IU/ml in Group 1 and 662.08 IU/ml in Group 2. The incidence of bronchial asthma in patients of allergic rhinitis was 36%, while the incidence of allergic rhinitis in patients in bronchial asthma was 74%. CONCLUSION: Thus, in our study, we found that both the diseases were closely linked clinicopathologically epidemiologically as well as immunologically pointing toward the concept one-airway one disease.

Introduction: The role of vitamin D in bone homeostasis is well known but nowadays, its role in various essential body processes including prevention of various infective and chronic illnesses like Tuberculosis (TB), by facilitating adaptive and innate immunity in lungs and peripheral blood, is being a matter of debate. Low levels have been associated with respiratory tract infections like TB. Present study aimed to evaluate the level of vitamin D in tubercular patients. Aim: To determine serum vitamin D level in patients with TB and compare it with controls. To compare serum vitamin D level among different types of TB, including Pulmonary TB (PTB), tubercular lymphadenitis and tubercular pleural effusion. Materials and Methods: The present study was a single centre cross-sectional study done during the study period from September 2013 to September 2016 at a tertiary care centre of Uttar Pradesh, India. Total 216 subjects aged between 21 and 60 years were included randomly out of which 113 patients were cases and 103 were controls. Cases of TB were confirmed by sputum Acid Fast Bacilli (AFB) staining, sputum and pleural fluid cytology, Adenosine Deaminase (ADA) of pleural fluid and Fine Needle Aspiration Cytology (FNAC) of lymph nodes. Controls were healthy subjects. Total serum vitamin D levels were measured by Diasorin competitive Radioimmunoassay (RIA) (Autoimmune Diagnostika, GmbH, Strasburg, Germany). Results: The mean serum vitamin D level for patients with TB was 22.4±8.5 ng/mL. Among controls, it was 30.5±8.6 ng/mL (p

The phenomena of global software development (GSD) face many challenges that are specifically associated with software process improvement (SPI). The main objective of this work is to develop the prioritization-based taxonomy of the SPI success factors using the fuzzy AHP approach. Total of twenty-one factors were extracted from the available literature that were further evaluated by conducting questionnaire survey with the SPI experts. In the second stage, multi-criterion decision making (MCDM) fuzzy AHP tool was used to prioritize and develop the taxonomy of the identified factors and their categories. The implications of fuzzy AHP approach are novel in this research area as it has been successfully used previously in different other domains e.g. electrical and electronics, supplier selection, agile software development and personnel selection. The contribution of this study is not only limited to the development of the factor’s taxonomy, but also their proper prioritization by introducing the novel fuzzy AHP approach in the research field of GSD and SPI, which assist to remove the vagueness and uncertainty in the opinion of the process improvement experts.

Background: Isoniazid (INH) and rifampicin (Rif) are the key first-line antituberculosis drugs, and resistance to these drugs i.e., multi-drug-resistant tuberculosis (MDR-TB), is likely to result in treatment failure and poor clinical outcomes. India has the highest burden of TB and MDR-TB in the world, disproportionately high even for India's population. The GenoType® MTBDRplus molecular method allows rapid detection of Rif and INH resistance. Aim: The present study was done to compare the performance of line probe assay test (GenoType® MTBDRplus) with solid culture method for an early diagnosis of MDR-TB. Methods: Totally 1503 sputum samples of MDR-TB suspects were subjected to fluorescent microscopy. Decontamination was done by N-acetyl-L-cysteine and sodium hydroxide method. Fluorescent microscopy-positive samples were subjected to GenoType® MTBDRplus (HAIN Lifescience) assay. Sixty-two random samples were compared with phenotypic drug susceptibility testing (DST) (1% proportion method) using solid culture method by Lowenstein–Jensen media. Results: The sensitivity, specificity, positive predictive value and negative predictive value for detection of resistance to Rif were 94.74%, 95.35%, 90% and 97.62% and to INH were 92.00%, 91.89%, 88.46% and 94.44%, respectively, in comparison with the phenotypic DST. Conclusion: GenoType® MTBDRplus has good sensitivity and specificity in detecting MDR-TB cases with a significantly lesser turnaround time as compared to conventional DST method and simultaneous detection of Rif and INH resistance. This technique saves several weeks of time required for culture and DST.

A 60 years old lady, a diagnosed case of hypertension and hypothyroidism, admitted in CMH Dhaka with the complaints of high grade continuous fever, headache, vomiting and lower abdominal pain following total hysterectomy about two weeks back. On general and physical examination, she was found febrile, mildly anaemic, pitting oedema over both legs and erythematous skin rash over face, trunk and extremities. Relevant laboratory investigations were done including bone marrow aspiration which revealed haemophagocytic lymphohistiocytosis. Journal of Armed Forces Medical College Bangladesh Vol.11(2) 2015: 89-90

Presently, global software development(GSD) is gaining a much attention from the softwaredevelopment organizations. In GSD, the agile developmentbecomes more challenging due to the geographically,socio-cultural and temporal boundaries.Several frameworks have been developed to managethe agile development programs in large scale softwaredevelopment organizations e.g. scaled agile framework(SAFe), large-scale scrum (LeSS) and disciplined agiledelivery (DAD). However, these frameworks arelacking to provide the detail information about theagile development programs in GSD environment. Inthis study, the mentioned research gap has been triedto fill by conducting a systematic literature review(SLR) study to identify the key factors that couldpositively impact the agile development activities inGSD environment. Using SLR approach, a total of 15success factors were identified that could positivelyaffect the agile development in GSD environment.The identified success factors were further categorizedinto two broad categories of client and vendor GSDorganizations. Client-vendor classification was used toprovide a broad picture of agile programs, and theirrespective success factors. Moreover, the identifiedfactors were also mapped into six different categoriesbased on a model of process improvement.

Introduction: Tuberculosis (TB) remains a significant public health problem with an estimated onethird of the world’s population being infected. Cytokines play a major role in protection against Mycobacterium tuberculosis infection and regulate the immune responses at cellular level. Most studies on cytokines during TB are from ‘in vitro’-stimulated lymphoid cells with few reports on in vivo plasma levels. This study was aimed to evaluate the levels of TNF-α & IL4 in new, underOriginal Research Article Fatima et al.; BMRJ, 7(4): 159-166, 2015; Article no.BMRJ.2015.107 160 treatment (UT) and multidrug resistant (MDR) pulmonary and extra-pulmonary cases. Methodology: The study was conducted at the Department Of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India. Levels of TNF-α and IL-4 were measured in 76 serum samples from TB patients by ELISA kit (Diaclone France) along with 10 BCG vaccinated control. A complete clinical, radiological & treatment data was collected on questionnaire forms of each patients. Results: TNF-α levels were elevated in new (P 0.05). TNF-α and IL-4 levels showed no significant variations according to site of involvement in pulmonary vs. extra-pulmonary TB cases. Conclusion: An understanding of the development of this response may lead to insight into pathogenesis and novel therapies for TB.

Aim/Objective: Increase in incidences of pneumonia due to multi-drug resistant methicillin resistant Staphylococcus aureus (MRSA) in both community and health care settings is of great concern globally. Present study aims to retrospectively analyze the efficacy of new fixed dose combination with antibiotic adjuvant entity (FDC) in comparison with vancomycin to treat patients with multi-drug resistant MRSA pneumonia. Materials and Methods: During this retrospective study, case sheets of patients who were treated for MRSA pneumonia with vancomycin or fixed dose combination of vancomycin + ceftriaxone + adjuvant (FDC) between 20 March 2010 to 20 October 2014 at tertiary care center, were analyzed. Various demographic features, antibiotic therapy, length of treatment duration and the resulting efficacy were evaluated. Microbiological success was measured in terms of bacterial eradication, while clinical success was monitored in terms of complete omission of systemic signs and symptoms. Results: Among 136 patients analyzed, 113 cases were having positive culture for MRSA, and hence were further analyzed. Out of these 113 patients, empirical treatment with vancomycin was given in 59 patients and 54 patients were treated with FDC empirically. After initial culture reports, 22 patients showing resistance to vancomycin were shifted to FDC. Amidst all the patients, 24 (64.86%) of 37 from vancomycin group and 62 (81.57%) of 76 from FDC group achieved clinical success. 9 patients out of these failure cases were cured with FDC + colistin combination therapy. Failure rates in FDC treated patients were significantly low (6.57%) as compared to vancomycin group (13.51%). Conclusion: For the treatment of different types of multi-drug resistant MRSA pneumonia, the empirical intravenous FDC therapy was safe and well tolerated with higher efficacy than vancomycin. Most of the vancomycin failure cases responded to FDC therapy and were cured. This retrospective study also concludes that an alternative option of FDC + colistin is safe and effective to treat the patients which fail to respond to FDC monotherapy.

Supply chain coordination in manufacturing sector has been the key focus of many research scholars since last four decades; however, research of tourism supply chain (TSC) management (SCM) has gained little attention. The unique characteristics of tourism sector call for special consideration to satisfy various stakeholders having divergent business objectives across different operating systems. This calls for a holistic view of the entire supply chain and not just playing in silos. The present chapter studies the important features of tourism products/services and identifies issues that are core to managing the supply chain in the tourism sector with the ultimate objective to achieve coordination of the TSC. The chapter gives an overview of current studies in tourism from the perspective of supply chain coordination and provides a coordination framework and stresses the role of information sharing for successful implementation of the coordination mechanism.

Pulmonary Tuberculosis (PTB) and Community-Acquired Pneumonia (CAP) are common causes of consolidation patch in chest radiograph. Sputum Z-N staining is positive in 30% to 60% cases only and sputum examination has poor yield in CAP. This study aimed to assess the value of serum Procalcitonin (PCT) levels in patients with Pulmonary Tuberculosis (PTB) and Community-Acquired Pneumonia (CAP). Patients with new opacity in chest radiograph were included in the study. Serum sample were taken at admission and stored. Patient’s diagnosis were confirmed and categorized into pulmonary TB group (32) and community-acquired pneumonia group (23). Their mean PCT level was compared with mean PCT level of 25 controls. Serum procalcitonin levels were found to be significantly elevated in patients of community-acquired pneumonia as compared to patients of pulmonary tuberculosis. In presence of consolidation in x-ray chest, increased level of serum procalcitonin might be used to differentiate pulmonary tuberculosis from community-acquired pneumonia. High level of serum procalcitonin was associated with high mortality rate in community-acquired pneumonia patients.

Pulmonary Tuberculosis (TB) is a global public health threat. It has a worldwide distribution with a very high prevalence in Asian countries. A correct diagnosis forms an important and indispensable part of proper and timely treatment. Detection of acid fast bacilli in direct smears has considerable clinical and epidemiological value and remains the most widely used rapid diagnostic test. In smear negative cases, radiography has an important role to play. Directly Observed Treatment Short Course (DOTS) strategy is one of the most cost-effective health interventions to treat tuberculosis. Samples from clinically suspected cases of TB were screened for the presence of Acid Fast Bacilli (AFB). Radiography and culture was done for the AFB negative cases. 760 cases of pulmonary TB were diagnosed by smear examination and 412 by radiography. 270 cases of pulmonary TB were diagnosed in the study. Of the 1422 patients put on DOTS, out of which 1138 (80.1%) were successfully treated. Thus, smear examination for AFB and radiography should go hand in hand for correct diagnosis and treatment of TB by DOTS which is a very successful regimen for developing countries like India.

Global software development (GSD) is a modern approach that is currently being adopted by software organisations, mainly because of significant return on investment it produces. In the GSD projects, the development teams operate under the three distributed dimensions: geographical, cultural and temporal distances which increases substantial communication difficulties and becomes the development activities more challenging especially related to requirement volatility. The objective of this study is to identify the relationship between requirements volatility, and GSD project success. We have proposed a GSD risk-based model that consider project performance risk as a mediating variable for analysing the impact of requirement volatility on GSD project success. A questionnaire study was conducted from the 103 GSD experts to validate the proposed model. The findings reveal that requirements volatility increases the project performance risk which has a negative impact on the GSD project success which can be managed by the flexible management.

Background Ceftriaxone–sulbactam–disodium EDTA (CSE) is being developed for Gram-negative infections caused by multidrug-resistant (MDR) bacteria. PLEA was a Phase 3, double-blind, multicenter, randomized study of CSE vs. meropenem (MR) for treatment of adults with complicated urinary tract infections (cUTI) or acute pyelonephritis (AP). Non-inferiority of CSE over MR at the EMA/FDA primary endpoints has been reported. The effect of baseline MIC on clinical and microbiological outcome at the test of cure (TOC) visit was investigated. Methods Adult patients were randomized 1:1 to receive either CSE (1 g ceftriaxone/500 mg Sulbactam/37 mg EDTA) every 12 h or MR 1g every 8 hours as 30 minutes IV infusion for 5–14 days. Oral step-down therapy was not allowed. Prior to dosing, urine specimens were collected, and MICs were conducted using CLSI methods for both study drugs. Patients that were nonsusceptible to MR were not included in the mMITT population. Results Of 230 subjects randomized, 143 (62.2%) were included in the mMITT population. Baseline Enterobacteriaceae was found in 131 (91.6%) patients, 67/74 (90.5%) in CSE and 64/69 (92.8%) in MR arm. Mean duration of IV therapy was 7 days. Favorable clinical and microbiological outcomes were observed in ≥90% patients for all MICs across the two study groups, with the exception of MIC 1 μg/mL in MR (associated with >20% failures). Overall, both clinical cure and microbiological eradication rates were higher in CSE as compared with MR (95.9% Vs. 89.9% and 94.6% vs. 88.4% respectively) (Table 1). CSE MR MIC(μg/mL) Clinical Cure n/N (%) Microbiological Eradication n/N (%) MIC(μg/mL) Clinical Cure n/N (%) Microbiological Eradicationn/N (%) 97% for MICs up to 4 μg/mL and is a potential new treatment option in patients with cUTI or AP. Disclosures P. Mandale, Venus Medicine Research Centre: Employee, Salary. M. A. Mir, Venus Medicine Research Centre: Employee, Salary. S. Chaudhary, Venus Medicine Research Centre: Employee and Shareholder, Salary. M. Chaudhary, Venus Medicine Research Centre: Board Member and Shareholder, Salary. A. Pyasi, Venus Medicine Research Centre: Employee, Salary.

Introduction: Nosocomial infections have been considered as a major health problem causing incremental morbidity, mortality and costs of therapy. Aim: This retrospective study was initiated with aim to analyse the comparative efficacy of a novel Antibiotic Adjuvant Entity (AAE), a combination of ceftriaxone + sulbactam + disodium edetate and meropenem in combination with colistin, for the management of Multi Drug Resistant (MDR) nosocomial Gramnegative bacterial infections. Materials and Methods: Case history sheets of patients with documented MDR nosocomial Gram-negative infections who received either AAE or meropenem in combination with colistin for management of infections over a period of 3 years (November 2012 – October 2015) were included in the study. Data related to clinical management, demographics, vital signs and laboratory parameters along with prior antibiotic therapy, dose and clinical outcomes were evaluated thoroughly to analyse the clinical benefits of this new AAE+ colistin therapy for management of MDR nosocomial infections. Results: Out of 115 patients short listed for the study, 52 patients had received AAE + colistin therapy and 63 patients have received meropenem + colistin. AAE + colistin therapy resulted in significantly higher efficacy (86.53%) as compared to meropenem + colistin (63.49%). A rising trend in clinical cure rates was observed in AAE based combination therapy in contrast to the decreasing trend in meropenem based combination therapy. A progressive decline in clinical cure rates was observed in meropenem treated group over a period of 3 years due to rising carbapenemases and multiple resistance by pathogens, where as AAE maintained the same efficacy. Conclusion: The AAE + colistin therapy has shown better bacteriological and clinical efficacy as compared to meropenem + colistin in the management of various nosocomial MDR Gramnegative infections. A significant number of meropenem failure patients responded to the AAE therapy highlighting the new hope to spare carbapenems.

Purpose: To study the factors influencing sputum smear conversion including Serum C-Reactive Protein (CRP) and its correlation with disease severity in tuberculosis patients. Method: Levels of Serum-CRP concentrations were deter-mined in 60 patients with pulmonary tuberculosis, 30 healthy volunteers and patients in follow-up after completion of antitubercular treatment (DOTS therapy). Results: Serum-CRP levels were found to be significantly higher in smear-positive group as compared with the follow-up patients and smear-negative control group. The values were 43.65 ± 23.68, 9.88 ± 5.23 and 4.04 ± 3.85 mg/L respectively (P Conclusion: Serum-CRP levels are significantly correlated with disease severity in patients with active pulmonary tuberculosis. Thus these findings from the present study would certainly add new criteria for early diagnosis of TB, which may lead to development of new strategies to treat TB.

Context: Asthma is a chronic airway disorder which is associated to the inflammatory cells. Inflammatory and immune cells generate more reactive oxygen species in patients suffering from asthma which leads to tissue injury. Aims: To investigate the role of oxidant-antioxidant imbalance in disease progression of asthmatic patients. Settings and Design: In this study, 130 asthmatic patients and 70 healthy controls were documented. Methods: For this malondialdehyde level, total protein carbonyls, sulfhydryls, activity of superoxide dismutase (SOD), catalase, glutathione peroxidase (GPx), total blood glutathione, and total antioxidant capacity (FRAP) were measured. Statistical Analysis Used: Analysis of the data was done using unpaired student t test and one-way ANOVA analysis. P < 0.05 was considered significant. Results: The present work showed that the systemic levels of MDA (4.19 ± 0.10 nmol/ml, P < 0.001) and protein carbonyls (1.13 ± 0.02 nmol/mg, P < 0.001) were found to be remarkably higher in asthmatic patients while protein sulfhydryls (0.55 ± 0.01 mmol/l, P < 0.05) decreased as compared to controls (2.84 ± 0.12 nmol/ml, 0.79 ± 0.02 nmol/mg and 0.60 ± 0.02 mmol/l, respectively). We also observed decrease in activities of SOD (2047 ± 50.34 U/g Hb, P < 0.05), catalase (4374 ± 67.98 U/g Hb, P < 0.01), and GPx (40.97 ± 1.05 U/g Hb, P < 0.01) in erythrocytes compared to control (2217 ± 60.11 U/g Hb, 4746 ± 89.94 U/g Hb, and 48.37 ± 2.47 U/g Hb, respectively). FRAP level (750.90 ± 21.22 ΅mol/l, P < 0.05) in plasma was decreased, whereas total blood glutathione increased (0.94 ± 0.02 mmol/l, P < 0.05) as seen in control (840.40 ± 28.39 ΅mol/l and 0.84 ± 0.04 mmol/l). Conclusions: This work supports and describes the hypothesis that an imbalance between oxidant-antioxidant is associated to the oxidative stress which plays a significant role in severity of the disease.

Isolated pleural effusion is a very rare presentation of malignant melanoma. A 46 year-old male patient presented to us with complaints of shortness of breath during the previous month. A contrast enhanced computed tomography (CECT) imaging scan of his thorax showed right-sided pleural effusion with the absence of any mass lesion or mediastinal lymphadenopathy. Cytology of his pleural fluid showed pigmented cells suggestive of malignant melanoma. Staining of the pleural fluid cells with immunohistological markers for melanoma (HMB 45 and S 100) were positive. An examination of his skin did not reveal any pigmented lesion, nor was there a past history of malignant melanoma for this patient. The patient responded well to therapy for malignant melanoma and has remained asymptomatic for the last year. This patient was diagnosed with a rare case of primary malignant melanoma of the pleura presenting as isolated pleural effusion.

Software organizations are increasingly combining agile methodologies and distributed software development (DSD) for efficiently and effectively built software products. There are numerous...

Objectives: Diabetes mellitus and thyroid dysfunction are the two most common endocrinopathies seen in general population. The study was done to determine whether there is any co-occurence of thyroid hormonal status alternating in newly diagnosed type 2 diabetes mellitus.Patients and Methods: This Cross-sectional study which was carried out at National Institute of Nuclear Medicine and Allied Sciences and outpatient Department (OPD) of Endocrinology of Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka during the period January 2015 to July 2016. A total of 98 newly diagnosed type 2 diabetic patients (Group I) and 98 healthy individuals (Group II) were enrolled in this study purposively. After taking written consent, history of the study subjects was taken and clinical checkup was done. Age of the subjects of both the group were 30 years and above. Glycemic status of both the group was assessed by measuring fasting blood sugar, blood sugar two hours after 75 gm oral glucose and blood for HbA1C. Patients with type 1 and other form of diabetes mellitus and any condition that may impair glycemic control were excluded from the study. Thyroid hormonal status of both the group was evaluated by measuring patients’ serum TSH by Immunoradiometric Assay (IRMA) and serum FT3 and serum FT4 by Radioimmunoassay (RIA) method in NINMAS. All the data were digitized and analyzed using SPSS – 22.0 software.Results: In this study, mean age of the patients was 46.0 ± 9.7 years and 45.5 ± 7.7 years in group I and group II respectively. Male female ratio was 1:1.45 in group I and 1:1.08 in group II. Fasting blood sugar, blood sugar two hours after 75 gm oral glucose and HbA1c were significantly higher in group I than that of group II. Mean TSH, FT3 and FT4 were 2.37 ± 3.86 mIU/L, 6.35 ± 2.41 pmol/L and 15.79 ± 5.41 pmol/L respectively in group I whereas 2.28 ± 2.67 mIU/L, 6.59 ± 1.83 pmol/L and 16.25 ± 3.46 pmol/L respectively in group II. But there was no statistical significant difference between group I and group II. In group I, sixteen patients had thyroid disorder (seven had hyperthyroidism and nine had hypothyroidism). In group II, five patients had thyroid disorder (two had hyperthyroidism and three had hypothyroidism). The difference was statistically significant. Fasting blood sugar positively correlated with TSH, FT3 and FT4 in group I, similarly HbA1c correlated with TSH and FT4 but not with FT3 in group I.Conclusion: Thyroid disorder was 16.3% in newly diagnosed type 2 diabetic patients and 5.1% in normal individuals.Bangladesh J. Nuclear Med. 20(1): 27-31, January 2017