bluuebunny/crossref_metadata_2025 huggingface dataset:
ASSESSING THE PLANNING AND IMPLEMENTATION OF THE EU MISSIONS AND OPERATIONS: CASE STUDY OF EUFOR ALTHEA IN BOSNIA AND HERZEGOVINA
Authors: BOŠTJANČIČ PULKO IVANA , Suhonen Johanna , Sainio Kari
Published: November 2020

Povzetek

Evropska unija je vzpostavila tesne povezave z državami Zahodnega Balkana v zadnjih tridesetih letih, predvsem zato, da bi zagotovila stabilno, uspešno in dobro delujočo demokratično družbo pri vključitvi v Evropsko unijo. Tudi takratna Evropska varnostna in obrambna politika (EVOP), pozneje preimenovana v Skupno varnostno in obrambno politiko (SVOP), je bila umeščena visoko v političnem programu agende Evropske unije. Nato je predal operacijo Sfor v Bosni in Hercegovini, katere naloga je ohranjanje varnosti v regiji, in Evropska unija je 2. decembra 2004, devet let po koncu vojne, začela operacijo Althea. Eufor Althea je najdaljša vojaška operacija Skupne varnostne in obrambne politike v zgodovini do zdaj. V prispevku so opisani pridobljene izkušnje in vidiki ter posledice zmogljivosti načrtovanja operacije. Temelji na intervjujih, izvedenih v BiH, pri čemer se upoštevata tako Evropska unija kot zunanji vidik glede tematike. Na začetku naj bi bil okvir SVOP predviden kot kratkoročni instrument. Avtorica sklene, da mora Evropska unija, če želi učinkovito načrtovati in izvajati zapletene dolgoročne civilne in vojaške misije ter operacije, ustrezno prilagoditi mandate in svoj splošni pristop. Eufor Althea naj bi kljub dolgotrajni prisotnosti na terenu in brez znakov umika v bližnji prihodnosti dosegla uspeh, in sicer predvsem pri ohranjanju varnega okolja, spodbujanju človekovih pravic in enakosti spolov ter krepitvi zmogljivosti oboroženih sil Bosne in Hercegovine, prav tako naj bi k omenjenim dosežkom prispevala tudi zmogljivost načrtovanja.

Ključne besede: Evropska unija, Bosna in Hercegovina, SVOP, Eufor Althea, načrtovanje, učinkovitost.
LEGALITY OF LOW-INTENSITY CYBER OPERATIONS UNDER INTERNATIONAL LAW
Authors: ŠARF PIKA
Published: November 2020

Povzetek Namen tega prispevka je obravnava mednarodnopravne ureditve nizkointenzivnih kibernetskih operacij. Čeprav mednarodna skupnost soglaša, da mednarodno pravo ureja ravnanje držav v kibernetskem prostoru, ni popolnoma jasno, kako se veljavna pravila mednarodnega prava uporabljajo v kibernetskem kontekstu. Večina pravnih strokovnjakov in strokovnjakov za nacionalno varnost ter vojaških strategov se je osredotočila na kibernetske operacije, ki dosegajo prag oboroženega spopada ali uporabe sile, vendar pa je le nekaj kibernetskih operacij v preteklosti ta prag tudi v resnici doseglo. Kibernetske operacije nižje intenzivnosti prevladujejo v kibernetskih odnosih med državami. Pri analizi skladnosti nizkointenzivnih kibernetskih napadov z veljavnimi pravili mednarodnega prava, zlasti z načelom ozemeljske suverenosti in načelom nevmešavanja, se članek opira na ugotovitve mednarodne skupine strokovnjakov, ki je pripravila t. i. Talinski priročnik uporabnega prava za področje kibernetskih operacij, in na mnenja drugih priznanih pravnih strokovnjakov. Ključne besede: kibernetska operacija, mednarodno pravo, načelo ozemeljske suverenosti, načelo neintervencije. Abstract The purpose of this article is to discuss the international law regulation of low-intensity cyber operations. Although the international community agrees that international law governs the conduct of states in cyberspace, it is not entirely clear how the existing norms of international law apply in the cyber context. The majority of legal scholars, as well as national security experts and military strategists, have focused on cyber operations that reach the threshold of either armed attack or use of force; however, few cyber operations in the past have actually risen to that level. Cyber operations of lower intensity prevail in state cyber interactions. While analyzing the accordance of low-intensity cyber operations with the existing norms of international law, in particular with the principle of state sovereignty and non-intervention, the article leans on the findings of the International Group of Experts which developed the Tallinn Manual on International Law Applicable to Cyber Operations, and writings of other recognized legal scholars. Key words: cyber operation, international law, principle of territorial sovereignty, principle of non-intervention.
THE CHARACTERISTICS OF THE SLOVENIAN ARMED FORCES AIR FORCE: NOW AND 20 YEARS IN THE FUTURE
Authors: LIPOVŠEK MITJA
Published: November 2020

Povzetek
V članku Slovensko vojaško letalstvo danes in čez 20 let nas avtor skozi kratko zgodovino vojaškega letalstva v Sloveniji popelje do trenutnih karakteristik slov-enskega vojaškega letalstva. V nadaljevanju avtor s pomočjo dejstev slovenske vojaške obrambne politike in fokusiranja Slovenske vojske (SV) na bataljonske bojne skupine predlaga karakteristike v razvoju slovenskega vojaškega letalstva, ki morajo poleg vloge podpore bojnim enotam SV temeljiti na združenih funkci-jah, kot so poveljevanje in kontrola (PINK); ognjena podpora; premik in manever; zaščita in vzdržljivost združenega bojevanja. Najpomembnejše vprašanje pa je, kaj je treba narediti, da bodo te karakteristike oblikovane na temeljih združenih funkcij. Vsekakor ima slovenska obrambna politika, podprta z vojaškim načinom mišljenja, pomembno vlogo pri postavitvi teh značilnosti.
Ključne besede: slovensko vojaško letalstvo, karakteristike, zavezništvo, združene funkcije.

Abstract
This article, ‘The Characteristics of the Slovenian Armed Forces Air Force (SA-FAF) : now and 20 years in the future’, will lead us through a brief history to-wards the characteristics of today’s Slovenian Armed Forces Air Force. In addi-tion, the article will, with the help of the Slovenian security policy through the Slovenian Armed Forces, whose focus is on Battalion Battle Groups, present the future characteristics of the Slovenian Armed Force Air Force, which, besides fulfilling a supporting role, should be built on a foundation of the joint functions – command and control (C2); intelligence; fire power movement and manoeu-vres; protection; and sustainment – of joint warfare. However, the key question is: what decisions should be made and what action taken to get us from here to there? Slovenian security policy, supported by a military way of thinking, plays the key role, and is the enabler for building new future characteristics based on joint functions.
Key words
Slovenian Armed Forces Air Force (SAFAF), characteristics, alliance, joint func-tions
PROTIOKLEPNI BOJ V SLOVENSKI VOJSKI
Authors: POTOČNIK VIKTOR
Published: November 2020

Povzetek
Od 90. let prejšnjega stoletja je v opremljanju z oklepno tehniko v oboroženih silah zaznati spremembe. Obseg tankovskih zmogljivosti se je zmanjšal, hkrati pa se povečujejo zmogljivosti tako imenovanega lahkega oklepa in oklepne zaščite v enotah bojne podpore in enotah zagotovitve bojnega delovanja. Dejansko se je delež oklepa na bojišču povečal. V doktrinarnem smislu Nato ne namenja veliko pozornosti protioklepnemu boju, v Vojaški doktrini SV (2006) pa protioklepnega boja sploh ne najdemo. V članku je opredeljen protioklepni boj v doktrinarnem smislu in analizirane so protioklepne zmogljivosti sodobnih vojsk. Na podlagi tega je predstavljenih nekaj ugotovitev in priporočil o stanju protioklepnega boja v SV.

Ključne besede: Protioklepni boj, protioklepni oborožitveni sistemi, Slovenska vojska, koeficient bojne učinkovitosti.

Abstract
Since the 1990's, several changes have occurred in armoured formations. The scope of tank capabilities has been reduced considerably, while at the same time the presence of light armour and armour in combat support and combat service support units has increased. The percentage of armour in the battlefield has thus increased considerably. Nevertheless, doctrine-wise anti-armour combat is not a high priority for NATO and it is not even mentioned in the Slovenian Armed Forces doctrine (2006). The article deals with anti-armour combat from a doctrine perspective, and provides an analysis of anti-armour capabilities of modern armed forces. Building on this, it puts forward some conclusions and recommendations for the Slovenian Armed Forces.

Key words: Anti-armour doctrine, anti-armour weapon systems, Slovenian Armed Forces, combat effectiveness coefficient.
ANALITIČNI PRISTOP K NAČRTOVANJU VIROV IN SPREJEMANJU ODLOČITEV V OBRAMBNEM SISTEMU
Authors: FAGANEL ROMAN , ČEVRIZ DRAGOMIR
Published: November 2020

Povzetek V prispevku opredeljujemo ožji koncept načrtovanja obrambnih virov (poudarek je na finančnih virih), ki temelji na dejanjih in rezultatih ter presega odločitve le na podlagi intuicije za doseganje boljših rezultatov pri odločanju, razporejanju in načrtovanju vojaških sredstev ter zmogljivosti. Viri v sodobnih vojaških organizacijah so omejeni in prav njihova načrtna/namenska dodelitev in racionalna izraba oziroma poraba predstavlja velik izziv sodobnega načrtovanja. Za doseganje optimalnih rezultatov je zelo pomembno razumevanje in poznavanje obstoječih virov, njihovo razporejanje in upravljanje znotraj vojaške organizacije. Nepravilno razporejeni viri prinašajo dodatne negativne posledice, kot so višji stroški, tehnološki zaostanek in zmanjševanje možnosti reševanja življenj. Z analitičnim pristopom upravljanja se oblikuje temeljna podlaga za raziskovanje vzrokov, procesov in pojavov odstopanj od načrtovanja virov skozi kratkoročna, srednjeročna in dolgoročna obdobja obrambnega načrtovanja. Predstavljena je metodologija procesa obrambnega načrtovanja, ki je osredotočena predvsem na kvantitativne pristope kot komplementarni del kvalitativnemu segmentu raziskovanja. Ključne besede: Upravljanje virov, intuicija, analiza stroškov in koristi, ekonomska analiza, matematični analitični modeli, proces odločanja. Abstract In the article, we define a narrow concept of defence expenditure planning (with the emphasis on financial resources), which is based on the acts and results and exceeds intuition-based decisions and achieve better results in decision making, allocating and planning of military assets and capabilities. Resources in modern military organizations are limited and it is their planned or eligible allocation and rational use and consumption that represent a major challenge in modern planning. In order to achieve optimum results, understanding and awareness of the existing resources, their allocation and management within a military organization are crucial. Incorrectly allocated resources bring additional adverse consequences, such as higher costs, technological backlog and reduced possibility of saving lives. An analytical management approach creates the basis for exploring the causes, processes and phenomena of deviations from resource planning through short-term, medium-term and long-term defence planning periods. The article presents the methodology of the defence planning process, which is mainly focused on quantitative approaches as a complementary part of the qualitative research segment. Key words: Resource management, intuition, cost-benefit analysis, economic analysis, mathematical analytical models, decision-making process.
ZANESLJIVOST POSAMEZNIKA PRI DELOVANJU KRITIČNE INFRASTRUKTURE SODOBNE DRŽAVE
Authors: BERTONCELJ BRANE
Published: November 2020

Povzetek Vpliv posameznika na delovanje kritične infrastrukture je eden najbolj nezanesljivih in nepredvidljivih dejavnikov, zato pomeni zanjo stalno nevarnost, ki je ne smemo podcenjevati. Postavlja se vprašanje, koliko si prizadevati za še večji tehnološki napredek, da bi bile tehnološke in fizične sestavine kritične infrastrukture varnejše, po drugi strani pa, kako obravnavati posameznika pri upravljanju teh kompleksnih sistemov, saj ta postaja vse pomembnejši referent za njeno zanesljivo delovanje. Avtor predstavlja okvir modela vpliva posameznikove zanesljivosti na delovanje kritične infrastrukture sodobne države. Ugotavlja, da je zanesljivost posameznika v neobičajnih razmerah najbolj odvisna od stopnje njegove motiviranosti, usposobljenosti in pripadnosti organizaciji. Samovarovalne dejavnosti in preprečevanje možnosti za neobičajne razmere so pretežno prostovoljna dejanja, pri katerih sta najpomembnejša pojma pripravljenost in volja nekaj koristnega delati za organizacijo. Za zanesljivo delovanje posameznika moramo imeti vizijo in cilje. Ključne besede: posameznikova zanesljivost, kritična infrastruktura, tveganja, neobičajne razmere, odločanje. Abstract The influence of individuals on the operation of critical infrastructure is one of the most unreliable and unpredictable factors, and as such represents a constant threat that should not be underestimated. The question arises as to how much effort to invest in the technological progress in order to make technological and physical components of critical infrastructure safer, and, on the other hand, how to deal with individuals in the management of these complex systems, as individuals are becoming an increasingly important reference point to insure its reliable operation. The author presents the framework of the model of the influence individuals' reliability has on the operation of a modern state critical infrastructure. He notes that the reliability of an individual in unusual circumstances mostly depends on the level of their motivation, competence and affiliation to the organization. Self-protective activities and the prevention of possible abnormal circumstances are predominantly voluntary acts, where the most important concepts are willingness and the will to do something useful for the organization. A reliable performance of an individual requires a vision and goals. Key words: Reliability of individuals, critical infrastructure, risks, abnormal situation, decision making.
Perillyl Alcohol in Solid Lipid Nanoparticles (SLN-PA): Cytotoxicity and Antitumor Potential in Sarcoma 180 Mice Model
Authors: Andrade Luciana N. , Cavendish Mariana S. S. , Costa Salvana P. M. , Amaral Ricardo G. , Corrêa Cristiane B. , Oliveira Douglas S. , Morsink Margreet , Gokce Evren H. , de Albuquerque Junior Ricardo L. C. , Souto Eliana B. , Severino Patricia
Published: November 2020

Cancer is a group of diseases characterized by the uncontrolled growth of cells. These cells in-vade organs and tissues by extension or direct dissemination and can spread to other regions of the body. Nanomedicine offers many possibilities to prevent the spread of cancer tissue and help cure the disease. In this work, solid lipid nanoparticles (SLN) were used to encapsulate perillyl alcohol (PA), a volatile monoterpene with proven anticancer activity. Encapsulation of PA into SLN (SLN-PA) is expected to promote controlled release, increase PA bioavailability, and impair the volatility of the monoterpene. SLN-PA prepared by high-shear homogenization showed average particle diameter around 254 nm, polydispersity index ~ 0.35, zeta potential ~ -14.7 mV, and encapsulation efficiency 84.6%. Scanning electron microscope analysis revealed a decrease in crystallinity, suggesting the encapsulation of PA in the SLN, confirming the spherical shape and the loading of the monoterpene in the SLN. In vitro cytotoxicity assays against murine fibroblasts (L929) showed that SLN-PA in both treated doses did not induce any cytotoxicity on non-tumoral cells. In vivo antitumor effect of the SLN-PA was evaluated in sarcoma 180-transplanted mice. The in vivo results demonstrated a significant tumor inhibition rate of 51.76 and 54.49% via intraperitoneal application of SLN-PA at doses of 100 and 200 mg/kg/day (p < 0.05), respective when compared to the nega-tive control (dimethyl sulfoxide). Adverse side effects of SLN-PA were not noticed in the liver, the kidney, or spleen tissue. The developed SLN-PA can be considered as a safe approach for site-specific antitumor effect in vivo, reinterpreting new nanoparticles-based cancer therapy.
Taming Cytokine Storm Syndrome (CSS) of COVID 19 infection: Are we far from reaching the finishing line?
Authors: Khan Rumi Ahmed
Published: November 2020

Abstract Not Available

Bangladesh Crit Care J September 2020; 8(2): 64-67
Clinical Features and Socio – Demographic Factors Affecting the Prevalence of Enteric Fever: A Prospective Observational Study
Authors: Saber Sadia , Alam Md Tarek , Yasmin Nazi , Hossain Mohammad Monwer , Alam Rafi Faria
Published: November 2020

Background: Enteric fever otherwise called Typhoid fever is a systemic disease caused by Salmonella typhi and Salmonella paratyphi, having reservoir in contaminated water and food. It affects considerable number of populations of the world but regions of South Asia are most commonly affected.

Aims and Objective: The objective of this study to find the prevalence of Typhoid fever with respect to age, gender, marital status, occupation, seasonal variation, treatment of drinking domestic water source, and clinical features.

Methodology: This is a cross- sectional observational study conducted at Bangladesh Medical College Hospital (BMCH), Dhanmondi, Dhaka from January to December 2019. Those presenting both outpatient departments or admitted to the inpatient units with complains of fever and abdominal pain underwent blood culture for the diagnosis of Typhoid fever. Patients with informed consent and positive blood culture report (including both Salmonella typhi and Salmonella paratyphi) were included in the study.

Results: Total 1375 tests were performed, out of which 407 came out to be positive blood culture report (including both Salmonella typhi and Salmonella paratyphi). Out of these tests 31.65% were males and 27.35% were females. Highest occurrence of typhoid fever was observed among males of age group 18 – 45 years and least with patients between age group above 75 years. As for the influence of occupation, male civil servants recorded the highest occurrence in the hospitals while artisans recorded the least. The influence of marital status revealed the highest occurrence in the single males with the married females had the least. In relation to months the prevalence was the highest in the month of July - September (11.42%). Water quality, vaccination and season have great impact on the burden of typhoid fever in population. Fever, diarrhea and abdominal pain are the major symptoms associated with typhoid fever.

Conclusion: Socio-demographic factors such as age, gender, marital status, and seasonal variation, treatment of drinking water supply, occupation and presenting complaints influenced the distribution pattern of typhoid fever among the population in BMCH, Dhanmondi, Dhaka.

Bangladesh Crit Care J September 2020; 8(2): 86-90
Serum Lipoprotein(a) Level and Apolipoprotein B/A1 Ratio in Patients of Hemodialysis and Peritoneal Dialysis: A New Approach to Predict Cardiovascular Risks in Chronic Kidney Disease
Authors: Feroz Salahuddin , Md Salahuddin Abu Zafor , Russel Md Al Rizwan , Islam Rafi Nazrul , Mozaffor Miliva , Selim Md Shahidul Islam
Published: November 2020

Background: Serum lipoprotein(a) and Apolipoprotein B/A1 ratio are new, independent cardiovascular risk factors in patients on dialysis. Conversely, the choice of dialysis procedure influences the uremic dyslipidemia in chronic kidney disease (CKD) patients.

Objective: To compare lipoprotein(a) levels and apolipoprotein B/A1 ratio in patients of chronic kidney disease (CKD) stage 5 undergoing hemodialysis or peritoneal dialysis.

Methods: This cross-sectional study was conducted in Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from September 2016 to March 2018. A total of 55 CKD stage 5 patients were included in the study – 31 in hemodialysis (HD) (group A) and 24 in continuous ambulatory peritoneal dialysis (CAPD) (group B). Group A patients were on low flux dialysis with bicarbonate dialysate 4 hours twice weekly dialysis with unfractionated heparin as anti-coagulant with a dialysis adequacy (Kt/V) >1.2. Group B patients were on 3 exchanges over 24 hours with 2 litres of 1.5% glucose fluid with a weekly measured Kt/V >1.7. Serum levels of Lipoprotein(a), Apolipoprotein B/A1 ratio were measured in both groups by using the standard laboratory technique.

Results: In group A, most of the patients were in 31-50 years age group (45.1%), while in group B, majority belonged to >50 years age group (54.16%). Patients’ gender showed a male predominance in both groups, i.e. 54.83% and 70.83% respectively. Most of the patients were from urban areas, i.e. 87.1% and 70.8% group A and B respectively. Dialysis adequacy (Kt/V) was found 1.46 for HD patients (group A) and 1.81 for CAPD patients (group B). Dyslipidemia was evident more in CAPD patients than HD patients, as per raised serum Lipoprotein(a) level (83.3% vs 74.1%) and raised Apolipoprotein B/A1 ratio (100% vs. 77.4%). Moreover, comparing with HD patients, CAPD patients showed increased level of serum Lipoprotein(a) (41.4±23.5 mg/dl vs 37.4±25.3 mg/dl; p>0.05) and Apolipoprotein B/A1 ratio (1.59±0.24 vs 1.04±0.22; p<0.001).

Conclusion: The maintenance CAPD treatment is associated with more pronounced alterations of the lipoproteins and lipid metabolism than those observed during HD treatment. Besides, serum lipoprotein(a) level and apolipoprotein B/A1 ratio were found simple, accessible and effective markers of dyslipidemia in both groups.

Bangladesh Crit Care J September 2020; 8(2): 91-95
Facing the Challenge of Post COVID-19 Pulmonary fibrosis: What is so unique about it?
Authors: Ghose Medha , Islam Tasbirul
Published: November 2020

COVID-19 pandemic is the highlight of the 21st century that took drastic effects on humanity. Over 23 million confirm infected with the majority with mild infection. However, over 62,000 cases are in critical condition with varying degrees of ARDS. A potential complication of severe ARDS could be Post COVID-19 Pulmonary fibrosis. Possible use of biomarkers to detect progression to fibrosis, along with prompt treatment of acute lung injury caused by COVID-19 and administration anti-fibrotic therapies, could be the next best method to treat this permanent and devastating sequela of COVID-19.

Bangladesh Crit Care J September 2020; 8(2): 102-107
Changing scenario of superficial fungal infection: Emerging resistance, recurrence and remedy in Bangladesh
Authors: Ahsan Mohammad Kamrul , Islam Mir Nazrul
Published: November 2020

Superficial fungal infections (dermatophytes) affecting skin, nail and hair are the most common infective dermatosis seen in dermatology outpatient clinics. There is a rising prevalence of dermatophytosis, especially in tropical countries like Bangladesh, with a concomitant increase in the number of difficult to treat cases. The reason for this phenomenon is not yet clear, but may be related to inadequate treatment regimen or discontinuation of medication, difficulties in eliminating predisposing factors and sources of re-infection. The pathogenesis and severity of fungal infection depend on various immunological and nonimmunological factors. The rampant use of antifungal therapy in immunocompromised individuals marked the onset of antifungal drug resistance. Fungal resistance can be microbiological or clinical. Genetic alterations in the fungi cause microbiological resistance. Clinical resistance is due to host or drug related factors. All these factors may cause fungal resistance individually or in tandem. Appropriate drug dosing along with antifungal drug susceptibility testing, especially for the dermatophytes isolated from chronic, recurrent cases or those with atypical presentation should be encouraged. Other ways to avoid resistance is the use of combination antifungal therapy. Combination therapy offers advantages in increased synergistic action with enhanced spectrum activity. Finally, newer insights into molecular mechanisms of drug resistance will help in the development of appropriate antifungal therapy. Till then experience based treatment of dermatophytosis is more effective than the standard guideline.

Bangladesh Crit Care J September 2020; 8(2): 108-111
Transplacentally transmitted organophosphorous compound poisoning in a newborn : Acase report and narrative review of literature
Authors: Begum Nargis Ara , Faruq Mohammad Omar , Siddiqua Shahnaz Parvin , Laila Runa , Sharker Suman , Akter Shirin
Published: November 2020

Organophosphorous compound (OPC) poisoning in the newborn is a medical emergency but completely treatable condition. Early recognition and treatment is of paramount importance in preventing fatality. A newbornmale of severe perinatal asphyxia was admitted in our neonatal intensive care unit (NICU) with a history of maternal OPC poisoning 31 hours before delivery. We treated the case on urgent basis, had stormy neonatal course and finally baby went home safely. OPC poisoning in newborn is a rare occurrence in the tropics. We report a rare case of transplacentally transmission of OPC poisoning innewborn and it is going to be 3rd and latest such reported case across the world upon literature search.

Bangladesh Crit Care J September 2020; 8(2): 120-123
SIADH in COVID 19 infection, an association or cause : A case report
Authors: Shamarukh Karishma , Rahman Sharmin , Chy Umme Kulsum , Sultana Amina , Faruq Mohammad Omar
Published: November 2020

One of the leading cause of hyponatremia is syndrome of inappropriate antidiuretic hormone secretion (SIADH). Various etiologies of hyponatraemia have been observed till today but its association with Covid leading to SIADH is rare. Therefore, we present a case where SIADH was associated with Covid-19 pneumonia. This was a case of a 66 years old male with multiple co-morbidities presenting with symptoms of Covid infection including generalized weakness. After confirming Covid 19 infection management was started accordingly but patient’s weakness seemed to increase. He was found to have low sodium level of 105 mmol /L and investigations confirmed that he was having SIADH. He was treated with hypertonic saline, fluid restriction and his symptoms and laboratory parameters gradually improved.

Bangladesh Crit Care J September 2020; 8(2): 126-128
Patient with COVID – 19 infection presenting with acute 6th cranial nerve palsy: A case report
Authors: Srijon SM Sanayet Bin Mustafiz , Khanam Rawshan Arra , Mimi Al Fateha Rahman
Published: November 2020

We present a case of a 55 year old lady, hypertensive and diabetic who was infected with COVID-19 presenting with acute 6th cranial nerve palsy. The patient was diagnosed with COVID-19 on Sept 01 2020. Seven days later she developed double vision and headache. At that point on complete neurological examination including examination of cranial nerves she was found to have 6th cranial nerve (Abducens) palsy with convergent squint. As the patients cranial nerves were all intact initially it is suspected that her 6th nerve palsy was related to the viral illness. She was assessed by ophthalmologist and neurologist. She underwent MRI scan of the brain to look for other causes of 6th nerve palsy and it was unremarkable. After almost one week of continued inpatient management her diplopia improved but she still complained of intermittent diplopia with convergent squint.

Bangladesh Crit Care J September 2020; 8(2): 129-130
Pneumothorax following rupture of lung cavity due to aspergillosis in a critically ill patient
Authors: Shrestha Gentle S , Sharma Sachit , Keyal Niraj , Acharya Subhash P
Published: November 2020

The incidence of fungal infection in intensive care units have been increasing over the years and Aspergillosis is one of the common fungal infections in the ICUs. It is a challenge for critical care experts to diagnose fungal infections on time and initiate appropriate management strategy to prevent adverse outcomes. Fungal infections may be notorious in not being diagnosed with a chest X ray alone as fungal infections related cavitary lesions may not always be seen in a chest X ray, necessitating the need of a CT Scan early on in the course of the illness. A chest CT scan may further be justified if the patient is not responding to a protracted course of higher antibiotics. Any delay in diagnosis may lead to poor outcome. Here we present a case who underwent subtotal gastrectomy for adenocarcinoma of stomach and presented one month later with fever, cough and shortness of breath. The patient was subsequently managed in the ICU but later expired following pneumothorax due to rupture of lung cavity associated with aspergillosis.

Bangladesh Crit Care J September 2020; 8(2): 131-133
Impact of COVID-19 on Medical Education in Bangladesh
Authors: Biswas Rajat Sanker Roy , Uddin Md Jalal
Published: November 2020

Abstract not available

Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 1-2
Telehealth Consultation in the COVID-19 Era: Utilisation and Challenges of Virtual Platform
Authors: Khanom Mehrunnissa , Chowdhury Shahanara
Published: November 2020

Abstract not available

Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 3-4
Complications of Ultrasound Guided Renal Biopsy in 100 Children: Experience at a Tertiary Care Hospital
Authors: Quader Mohammed Maruf Ul , Biswas Susmita , Datta Mitra , Chowdhury Muhammad Jabed Bin Amin , Haque Salina , Mohammad Moinuddin Kazi , Sen Sunanda , Bappy Sawrav Deb
Published: November 2020

Background: Use of automated device with ultrasound guidance in renal biopsy has improved the adequacy and reduced the complication. Chittagong Medical College Hospital (CMCH) is a tertiary teaching hospital where Pediatric Nephrology Department started its journey on 11th December 2013. Since then renal biopsy is going on. Aim of the study is to see the rate of adequacy and complication of renal biopsy along the course of years.

Materials and methods: This is a retrospective study carried on 100 consecutive ultrasonography guided percutaneous renal biopsy from lower pole of left native kidney performed by the pediatric nephrologist. All hospitalized children aged up to 12 years admitted since 2014 were included. Spring loaded automated biopsy needle was used in 88% cases and Trucut biopsy needle in 12% cases.

Results: Most of the patients were aged between 1 to 10 years with male female ratio 0.9:1. Midazolam was used for sedation in all patients except one who needed general anesthesia. Light microscopy and Direct Immunofluorescence (DIF) report was made but no facility for electron microscopy. Gross hematuria was experienced in 5% cases and one case needed blood transfusion. There was one case with blood clot in urinary bladder causing dysuria but no urinary retention was observed. Post biopsy perinephric hematomas developed in 4 cases. Number of needle passes to obtain adequate biopsy material in native kidney was £3 in 78% cases. Adequate specimen was found in 95% cases.

Conclusion: Percutaneous renal biopsy can be done adequately and safely in resource poor setup if pediatric nephrologist and radiologists are available.

Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 9-12
A Study on Histopathological Pattern of Ovarian Tumours in Chittagong Medical College Hospital
Authors: Begum Mahmuda , Rahman Md Mukhlesur , Jahan Mahmuda , Rahman Zillur , Chowdhury Shahanara
Published: November 2020

Background: Ovarian tumours may either be asymptomatic, found on the routine ultrasound examination or symptoms may be vague till the patient has an acute emergency like torsion or rupture of a benign cyst. The worst is late presentation of malignant ovarian tumour. There is marked variation in the presentation of the tumour as well as in histological types. This study was under taken to analyse modes of presentation and various histopathological patterns of ovarian tumour.

Materials and Methods: A total of 69 cases were selected consecutively. The age range was 13-70 years. This study was carried out in the Department of Pathology, Chittagong Medical College and Department of Gynaecology and obstetrics, Chittagong Medical College Hospital during the period from July 2013 to June 2014. The specimens of ovarian tumours were subjected to histopathological examination in the histopathology section.

Results : Out of 69 cases, 54(78.3%) were benign and 15(21.7%) were malignant tumour. There was no borderline malignancy in our study. The commonest histological pattern in this study was surface epithelial tumour 49(70.6%) including both benign and malignant tumour followed by germ cell tumour 6(8.7%). The commonest benign tumour was serous cyst cyst adenoma 23(33.4) and malignant tumour was serous cyst adenocarcinoma 5(7.2%).

Conclusion : Surface epithelial tumours are the commonest variety of ovarian tumour followed by germ cell tumour. The histological type of ovarian tumour correlates with the prognosis of the tumour.

Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 13-17
Top Five Causes of Neck Mass in Chattogram
Authors: Chowdhury Ziaul Answar , Uddin M Jalal , Ahmad Ashfaq , Uddin Abbas , Chowdhury Nurul Karim , Hossain HS Mubarak , Chowdhury Mahbubul Alam , Majumder Dhananjoy
Published: November 2020

Background: Identifying top problems in any discipline is very important for diagnosis and effective management. Unfortunately there is a knowledge gap in Chattogram, Bangladesh. To fill up the gap we have conducted the study.

Materials and methods : It was a retrospective study based on hospital records of Chattogram General Hospital from January 2017 to December 2017. All (104) cases with neck mass were included. Age, sex, clinical diagnosis, histo-pathological diagnosis and management were noted. Data were managed manually.

Results: Total 104 cases were studied among the cases 65% were female and 35% were male. 91% cases were of 10-50 years age group. Highest cases 33% were found in 20-30 years age group. According to Histo-pathological report 25% cases were Tubercular lymphadenopathy, Nonspecific lymphadenopathy were 17% and Multi-nodular goiter were 15%. Results were contrasted with previous studies.

Conclusion: Top 05 causes of neck mass in Chattogram have been unveiled. Tuberculosis is still number one problem. So, TB control program should be evaluated further to find out causes of high TB cases in this region.

Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 18-20
Prelabour Rupture of Membrane : Maternal and Foetal Outcomes
Authors: Jamal Monira , Biswas Rajat Kumar
Published: November 2020

Background: The leading cause of perinatal morbidity and mortality is prematurity in developed and underdeveloped countries. In one third of the patients with preterm labour, there is associated premature rupture of membranes. The study was conducted to evaluate the clinical presentation of Pre-labour Rupture of Membrane (PROM) in pregnancy and obstetric outcome.

Materials and methods: This is a cross sectional study carried out in the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, between September 2013 to February 2014. About 50 women having PROM with more than 32 weeks gestational age who admitted in the above department for delivery were enrolled in this study.

Results: The mean age was found 27.4 ± 4.42 years with range from 17 to 41 years. Forty eight percent of PROM patient were primi and 52.0 percent of patients were multigravida. Six percent patients were illiterate. Almost two third patients were housewives. More than half (54.0%) of the patients were came from poor class income group family. Majority (64.0%) patients had term PROM (>37 weeks) gestational age and the mean gestational age was 38.1 ± 2.7 weeks with range from 32- 40 weeks. More than half (54.0%) didn't received any antenatal checkup. A total of (56.0%) patients had associated disease, out of which anaemia was more common. Twelve percent had diabetes mellitus and 8.0% had UTI infection. Almost two third (64.0%) was vaginal delivery and 18(36.0%) were caesarean section and common indication for caesarean section was fetal distress (38.9%). Two third patients were healthy and 17 patients had morbidities, wound infection is highest (29.4%). The mean birth weight was found 2.74 ± 0.7 kg. APGAR score >7 at 1 minute was found (92.0%) and (94.0%) at 5 minutes of birth of baby after birth. Fetal outcome take home alive (98.0%) and neonatal death 2.0%. Among 50 foetus morbidity develop in 26 cases. Among them respiratory insufficiency is highest (38.5%).

Conclusion: Motivation of the patients, health education, improvement of nutritional status of mother, neonatal care service, early diagnosis, treatment, overall institutional delivery is needed for reduction of neonatal morbidity and mortality, as well as maternal morbidity.

Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 23-27
Evaluation of Results of Extraperiosteal Plating of Pronation-Abduction Ankle Fractures in Adults
Authors: Kabir Tafhim Ehsan , Ahmad Salehuddin , Biswas Alak Kanti
Published: November 2020

Background: Pronation-abduction ankle fractures frequently are associated with substantial lateral comminution and is associated with the highest rates of nonunion among indirect ankle fractures. It is one of the common injuries occurring in adult age group where trauma is the main etiology. The present prospective hospital based observational study was conducted to evaluate the functional outcome of treatment of ankle fracture by extraperiosteal plating in a series of patients with pronation-abduction ankle fractures.

Materials and methods : A total of 30 consecutive patients aged over 18 years with pronation-abduction ankle fracture were included in the study and underwent surgery by extraperiosteal plating of the fibular fracture. Patients were selected irrespective of sex. The average age of the patients was 36.5 years. Patients with gustilo type III open fractures, pathological fractures were excluded from the study. The patients were evaluated functionally with the use of the American Orthopaedic Foot and Ankle Society score (AOFAS) radiographically, and clinically with range of motion testing.

Results: Immediate postoperative and final follow-up radiographs showed that most of the patients had a well-aligned ankle mortise on the fractured side as compared with the normal side on the basis of standardized measurements. All fractures healed without displacement. The average American Orthopaedic Foot and Ankle Society score was 81.5. The range of motion averaged 13° of dorsiflexion and 53° of plantar flexion. Satisfactory results were obtained in 93.33 % patients. Complication includes 2(6.66%) superficial infection, 1(3.33%) deep infection, 4(13.33%) delayed union, 1(3.33%) skin necrosis. Radiological evaluation revealed persistent of talar shift in 1(3.33%) patient postoperatively.

Conclusions: Extraperiosteal plating to be an effective method for the stabilization of pronation-abduction ankle fractures. The technique allows for accurate reduction of the mortise without stripping the periosteum of the comminuted region of the fracture. The technique is easier and faster than standard techniques in which the lateral periosteum is split to facilitate placement of the plate.

Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 32-36
Delay in the Diagnosis of Oral Malignancy : Study on Responsible Factors
Authors: Chowdhury Nurul Karim , U Kyaw Khin , Chowdhury Ziaul Answar , Uddin Md Abbas , Hossain HS Mubarak , Biswas Supran , Anwar Mostafa Mahfuzul
Published: November 2020

Background : Oral malignancy is an emerging disease all over the world. Treatment failure is grave if the diagnosis is delayed in this disease which will ultimately increase the mortality rate. This is an observational sociodemographic study, done to identify the causes in diagnostic delay of the patients suffering from oral cancer.

Materials and methods: The study was done with a sample size of 215 cases of oral cancer patients. This observational study was conducted from 1st August 2015 to 31st December 2016 at Upazila Health Complex, Mirsarai, Chattogram & later at ENT Department of Chittagong Medical College Hospital from 1st March 2017 to 30thApril 2018.

Results: Several causes of diagnostic delay were identified. Among them, monetary issue (78%) and Ignorance or Illiteracy (69%) have been found as the most important causes. Stage of the disease, delay in referral system, tobacco use, age, gender, alternative medicine, social taboo ,distance of hospital from house etc were found the other factors delaying the diagnosis of the cancer.

Conclusion: Many of the causes of delay can be preventable. The authority should establish awareness among the patients & a protocol for early detection of cancer by the health professionals.

Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 37-40
Study on Pregnancy Outcomes in Intrauterine Insemination Cycles with Motile Spermatozoa Insemination
Authors: Khanam Mafruha , Begum Rokeya , Banerjee Aditi , Jerin Jesmin , Fazyl Mohamed Mazih , Saadat Shan
Published: November 2020

Background: Intrauterine Insemination (IUI) is one of the most common assisted reproductive technology methods in the world to treat various forms of infertility. The influence of number of IUI applied with the percentage of motile spermatozoa during insemination is critical on the likelihood of a successful pregnancy. The aim of our study is to assess the results of IUI as a function of the number of IUI applied with motile spermatozoa inseminated during intrauterine insemination in couples with infertility.

Materials and methods: This is a prospective study conducted in Surgiscope Fertility Centre, Chattogram, Bangladesh over 21 months on 596 couples who underwent IUI from 01/12/2017 to 30/09/2019. We performed semen analysis of the male partner from the couples who underwent IUI, calculated the sperm motility and the relationship between number of IUI applied with motile spermatozoa and the pregnancy rate of IUI. Multiple variables were selected such as, patient parameters like age of female, number of IUI, percentage of motile spermatozoa inseminated, endometrial thickness and ovulation induction protocol which were recorded and statistically analyzed.

Results: Among the 596 patients, the overall success rate was 11%. The maximum number of successes were observed in patients with 3 IUI applications whereas the success rate was lower in comparison with decreasing IUI applications. The regression between the success and number of insemination and age indicate that there is a statistically significant positive relationship between number of inseminations completed and the rate of successful pregnancy, but no significant relationship between the number of prewash sperm and successful pregnancy. These could be due to lower population size. As an ovulation inducing agent, a 12.42% success rate was observed among the patients administered with FSH whereas 9.28% was observed for patients administered with GONAL F. The mean endometrial thickness was observed to be 8.914 mm with a minimum thickness of 4.5 mm and a maximum thickness of 19 mm.

Conclusion: The rationale for the use of insemination is to increase gamete density at the site of fertilization. This revealed that intrauterine insemination should be a firstchoice treatment rather than more invasive and expensive techniques of assisted reproduction in cases of cervical, unexplained and moderate male factor subfertility.

Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 41-45
Effects of Breast Feeding Practice in Respiratory Syncytial Virus Positive Bronchiolitis in Early Infancy
Authors: Shikder Nazrul Quader , Sadeque AJM , Begum Rabeya , Rahman Mizanur
Published: November 2020

Background: Bronchiolitis is a common respiratory illness. It can be diagnosed clinically, as well as by a few costly laboratory tests. It has no specific treatment except supportive measures. Respiratory Syncytial Virus (RSV) related Bronchiolitis carries near about 1% mortality and involve an economical load. The objective of this study was to compare effecte of breast feeding practice in relation with RSV positivity among bronchiolitis in early infancy.

Material and methods: This case control study is designed to evaluate the effects of breast feeding practice among the RSV positive bronchiolitis patients during a period of 1 year. A total 40 patients of bronchiolitis were evaluated who have exclusive breast feeding and non exclusive breast feeding. RSV positivity were analyzed among both groups and compared. Patients were selected after taking consent from guardians, patient diagnosed as bronchiolitis, age 2 month to 2 year and all tests are done in Department of Microbiology, Chittagong Medical College Hospital (CMCH). Results were evaluated to find out the effects of breast feeding practice in relation with RSV positivity bronchiolitis in early infancy.

Results: Among all 40 patients, male was 25(62.5%) and female was 15(37.5%). Male to female ratio was 1.67:1. Majority of guardians were workers 18(45%), service holder 11(27.5%) and businessman 10(25%). Regarding socioeconomic conditions of the parents where 26(65%) were poor and 14(35%) were rich. Twenty five (62.5%) were from rural areas and 15(37.5%) were from urban locality. Different history related with risk factors of bronchiolitis were evaluated where 11(27.5%) patients had H/O prematurity, 10(25%) had parental smoking history, nonexclusive breast feeding 13(32.5%) and supplemental feeding had 13(32.5%) cases. Regarding pattern of breast feeding 27(67.5%) were given exclusive breast feeding and non exclusive breast feeding were 13 (32.5%) of which only formula milk was given to 1(2.5%) case and cow’s milk and formula milk jointly was given in 12(30.0%) cases. Findings of clinical histories revealed that all 40 patients had cough, respiratory distress and excessive cry, cyanosis was present in 39(97.5%) cases and cent percent patients had chest in drawing and all of were categorized as severe bronchiolitis. Regarding RSV testing 15 (37.5%) cases were found to having RSV positive and remainder portion were negative. Significant association was found regarding RSV status and exclusive breast feeding where more negativity was found among those who were exclusively breast feed.

Conclusion: There is significant association between RSV positivity bronchiolitis andnon- exclusively breast feed children.

Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 46-49
Relationship Between Glycemic Control and Cardiovascular Outcomes
Authors: Chowdhury Sumon Rahman , Tanzil Tasnuva , Chowdhury Rezaul Haider , Alam Md Minhazul
Published: November 2020

Diabetes is a well-known cardiovascular risk factor in both T1DM and T2DM. They have a 4-10 higher risk of developing complications from CVD than the non-diabetic population. The importance of intensive glycaemic control to prevent CVD in T1DM was established in both “The Diabetes Control and Complication Trial” (DCCT) and “Epidemiology of Diabetes Intervention and Complications” (EDIC) trials. Despite the epidemiological evidence that poor glycaemic control can lead to higher incidence of cardiovascular events in T2DM, the intervention trials are still inconclusive. In this report we will highlight the pathophysiology of the effect of hyperglycemia on the cardiovascular system, the effect of medications, and the major Randomized Control Trials (RCTs) looking specifically at the cardiovascular outcome of intensive glycaemic control in T2DM.

Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 50-56
CME (Continuing Medical Education) & CMS (Combined Morning Session) January-June 2020
Authors: Uddin Mohammad Jalal
Published: November 2020

Abstract not available

Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 63
TINGKAT SOLVABILITAS PERUSAHAAN ASURANSI JIWA SYARIAH DI INDONESIA
Authors: Yulianti Nur Wachidah
Published: November 2020

This study aims to look at the mean difference of the solvability level of tabarru’ fund of sharia life insurance companies in Indonesia. The population of this research were full fledge life insurance companies from 2014 to 2019. This research was tested data through one-way analysis of variance (ANOVA) test. One way ANOVA test result shown that there is a significant mean difference between sharia life insurance companies in Indonesia at the solvability level of tabarru’ funds. Keywords: mean difference, ANOVA, life insurance, solvability