bluuebunny/crossref_metadata_2025 huggingface dataset:
Sea otter recovery buffers century-scale declines in California kelp forests
Authors: Nicholson Teri , McClenachan Loren , Tanaka Kisei , Van Houtan Kyle
Published: August 2023

The status of kelp forests and their vulnerability to climate change are of global significance. As the foundation for productive and extensive ecosystems, understanding the long-term trends in kelp is critical to coastal ecosystem management, climate resiliency, and restoration programs. In this study, we curate historical US government kelp inventories, develop methods to compare them with contemporary surveys, and use a machine learning framework to evaluate and rank the drivers of change for California kelp forests over the last century. Historical surveys documented Macrocystis and Nereocystis kelp forests covered approximately 120.4 km2 in 1910-1912, which is only slightly above surveys in 2014-2016 (112.0 km2). These statewide comparisons, however, mask dramatic regional changes with increases in Central California (+57.6%, +19.7 km2) and losses along the Northern (-63.0%, -8.1 km2), and Southern (-52.1%, -18.3 km2) mainland coastlines. Random Forest models rank sea otter (Enhydra lutris nereis) population density as the primary driver of kelp changes, with benthic substrate, extreme heat, and high annual variation in primary productivity also significant. This century-scale perspective identifies dramatically different outcomes for California’s kelp forests, providing a blueprint for nature-based solutions that enhance coastal resilience to climate change.
Korelasi Umur, Penghasilan Tetap, Pendidikan Terakhir dan Rata-Rata Pengeluaran Pada Rumah Tangga Miskin di Kota Pangkalpinang
Authors: Marlina Marlina , Nurwasya Nurwasya , Valeriani Devi , Wulandari Ayu
Published: August 2023

Kemiskinan menjadi salah satu masalah multidimensional yang harus diatasi. Kemiskinan memiliki karakteristik yang beragam. Karakteristik kemiskinan menjadi ciri-ciri individu atau kelompok tergolong keluarga miskin. Kemiskinan harus diatasi dengan kebijakan dan program pemerintah. Penelitian ini bertujuan untuk mengetahui dan menganalisis karakteristik kemiskinan di Kota Pangkalpinang. Pengumpulan data dilakukan dengan wawancara dan observasi serta kuisioner kepada 100 sampel responden yang terdaftar di DTKS (Data Terpadu Kesejahteraan Sosial) Dinas Sosial. Metode analisis yang digunakan adalah tabulasi data dan korelasi. Hasil penelitian menjelaskan bahwa kepala keluarga yang disurvei terbanyak memiliki berjenis kelamin laki-laki, berumur 36-43 Tahun, pendidikan terakhir SMA, dengan status pernikahan terbanyak menikah dan jumlah anak sebanyak 2 sedangkan banyak tanggungan sebanyak 3 orang dalam 1 keluarga. Berdasarkan hasil korelasi diperoleh korelasi umur kepala keluarga dan  penghasilan tetap kepala keluarga di Kota Pangkalpinang adalah negatif dan sangat lemah, korelasi penghasilan tetap kepala keluarga dan rata-rata pengeluaran kepala keluarga Kota Pangkalpinang adalah positif dan sedang, korelasi total penghasilan tetap dan rata-rata pengeluaran kepala keluarga Kota Pangkalpinang adalah positif dan sedang, serta korelasi pendidikan terakhir kepala keluarga dan penghasilan tetap kepala keluarga Kota Pangkalpinang adalah positif dan lemah.
Pengaruh Biaya Bahan Produksi, Biaya Pemasaran Dan Biaya Gaji Terhadap Profitabilitas Studi Kasus (Usaha Roti Bakery di Pangkalpinang
Authors: Deni Deri Kusma , Makrus Mohamad
Published: August 2023

Abstact : Production costs are costs used in the production process consisting of direct raw materials and factory overhead costs. These production costs are also called product costs, which are costs that can be associated with a product, where these costs are part of the inventory. Marketing costs are all costs incurred in the context of marketing a product or merchandise, which costs arise from the time the product or merchandise is ready for sale until receipt of the sale proceeds into cash. Labor costs are costs incurred for workers or employees who can be physically traced into the manufacture of products and can also be traced easily or without consuming much expense. The problem Research is how the influence of the cost of production materials, marketing costs and salary costs on profitability, how the influence of the costs of production materials on profitability (ROA), how the influence of marketing costs on profitability, how the influence of salary costs on profitability (ROA). This Research purpose to determine the correlated of simultaneous costs of production materials, marketing costs and salary costs on profitability (ROA), partial correlated of production material costs, marketing costs and salary costs on profitability (ROA) Analysis of the data used in this research is multiple regression analysis, the coefficient of determination (R2) is 0.540 meaning that 54.0% of the variation in profitability can be explained by the variable costs of production materials, marketing costs and salary costs, while 46.0% from other factors not examined in this study. The F test results obtained the calculated F value of 12.522 is greater than the F table of 2.90 or a significance of 0,000 <α (0.05), the hypothesis states that the variable costs of production materials, marketing costs and salary costs correlated on profitability. Based on the t test that the variable costs of production materials and salary costs affect profitability while the variable marketing costs have no correlated on profitability

Keywords: material production costs, marketing costs, salary costs, profitability
Analisis Perilaku Industri dari Segi Perputaran Piutang dan Profitabilitas (Return On Asset) " Studi Kasus di Pt. Caraka Jaya Sentosa
Authors: Sugiarti Sugiarti , Oktiyani Rina , Rahmiyatun Fitri , Aliudin RM Teddy , Apriliani Putri
Published: August 2023

PT. Caraka Jaya Sentosa merupakan perusahaan yang bergerak dibidang jasa pengiriman barang melalui udara, darat, dan laut. Profitabilitas merupakan salah satu faktor penilaian kinerja keuangan perusahaan yang bisa mengalami penurunan atau peningkatan karena dipenuhi oleh berbagai macam faktor. Indikator yang digunakan dalam penelitian ini adalah Return On Asset (ROA) karena Rasio Profitabilitas ini menunjukan keefisienan perusahaan dalam mengelola seluruh aktiva. Tujuan dari penelitian ini adalah untuk mengetahui pengaruh perputaran piutang terhadap tingkat profitabilitas perusahaan. Metode penelitian ini menggunakan metode kuantitatif. Teknik pengumpulan data dengan cara observasi, dan dokumentasi. Data dianalisis menggunakan Uji Normalitas, Uji Koefisien Korelasi, Uji Koefisien Determinasi dan Uji Persamaan Regresi Linier Sederhana. Hasil penilitian menggunakan Uji Koefisien Korelasi menunjukkan hubungan yang kuat dengan nilai 0,739 dan positif. Untuk Uji Koefisien Determinasi menunjukkan Perputaran Piutang terhadap Return On Asset (ROA) memiliki pengaruh yang signifikan yaitu sebesar 0,546 yang artinya < 0,05 sebesar 54,6% sedangkan sisanya 45,4% dipengaruhi oleh faktor lain yang tidak diteliti dalam penelitian ini. Hasil persamaan Regresi Linier Sederhana Y=-0,008+0,046X.
A Descriptive-Quantitative Analysis of Natural Resource Sub-Sectors and Their Impact on Regional Development Performance in Central Bangka Regency, Indonesia
Authors: Angraeni Septi , Kusumastuti Ratih
Published: August 2023

Central Bangka Regency is part of the Bangka Belitung Islands Province which is an integral part of the Unitary State of the Republic of Indonesia whose formation was based on Law Number 5 of 2003 concerning the Formation of South Bangka Regency, Central Bangka Regency, West Bangka Regency and East Belitung Regency in the Archipelago Province. Bangka Belitung. The purpose of the evaluation is to assist regional development planning documents, to identify potential natural resources sub-sectors in Central Bangka Regency related to regional development performance achievement indicators. The study approach used in this activity is descriptive-quantitative. Based on Location Quotient (LQ) analysis, there are 8 potential economic sectors or comparative advantage (base). There are 4 sectors that do not have a comparative advantage (non-base) or local and there are 3 sectors that are not potential (non-basic). Middle. In the second quadrant, there are commodities that have a slow growth rate but a large contribution to the GRDP of Central Bangka Regency. In the third quadrant, there are commodities that have a fast growth rate but a small contribution to the GRDP of Central Bangka Regency. In the fourth quadrant, there are commodities that have a slow growth rate and make a small contribution to the GRDP of Central Bangka Regency
How to improve Job Satisfaction and Organizational Citizenship Behavior through Transformational Leadership and Organizational Culture? (Study on Employees of PT Anugrah Agung Pratama Kota Kediri)
Authors: Fahreza Danastya , Setyono Langgeng , Nurtjahjono Gunawan
Published: August 2023

The corporation must increase employee voluntary attitudes, organizational citizenship behavior, and job happiness in order to enhance employees' potential job performance. This study is important for determining the effect of transformational leadership and organizational culture on work satisfaction and the promotion of organizational citizenship behavior. This study employs a quantitative methodology to collect data from 32 employees utilizing a saturation sampling technique. With the assistance of SmartPLS software, the data were analyzed using the PLS-based SEM approach. The results indicated that transformational leadership has no influence on job satisfaction, organizational culture has a significant positive influence on job satisfaction, transformational leadership has no influence on organizational citizenship behavior (OCB), organizational culture has an influence on OCB, job satisfaction does not mediate the influence of transformational leadership on OCB, but it does mediate the influence of organizational culture on OCB. These findings aid PT Anugrah Agung Pratama in increasing job satisfaction and employee OCB.
Prevalencia de consumo de alcohol y tabaco en adultos mayores de un centro gerontológico de Aguascalientes
Authors: González Mancilla Cynthia , Rodríguez Valenzuela Melanie Monserrat , Romo Martínez Karla Paola , Saucedo Germes Jakeline , Villalobos Alonso Fernanda Sofía , Ortega Rios Monica Yadira , Rodríguez Ramírez José Manuel
Published: August 2023

Introducción: el abuso en el consumo de sustancias como alcohol y tabaco es un problema de salud pobremente reconocido en el adulto mayor. El creciente número de adultos mayores con problemas de consumo alcohol y tabaco impondrá mayores demandas a los servicios asistenciales. Objetivo: determinar la prevalencia de consumo de alcohol y tabaco en adultos mayores de un centro gerontológico del estado de Aguascalientes. Metodología: estudio cuantitativo, descriptivo, no experimental, prolectivo, transversal. Conformado por una muestra no probabilística por conveniencia de 202 adultos mayores del DIF Estatal Centro Gerontológico en el estado de Aguascalientes, México. Se aplicaron los instrumentos Audit y la Escala Exploratoria de Consumo de Tabaco con un alfa de Cronbach de 0.86 y 0.97; para el análisis estadístico se utilizó el programa SPSS versión 22. Resultados: la prevalencia de consumo de alcohol fue del 59%, edad de inicio promedio a los 16 años, tipo de bebida cuyo consumo predomina es cerveza y tequila con 54.2% y 41.5%, respectivamente. Referente al tabaco la prevalencia fue del 48.5%, y el 31.4% consume más cuando consume alcohol. Conclusión: la población está en riesgo de que el consumo de alcohol siga incrementándose por distintos factores; mientras que en el consumo de tabaco se observa una dependencia más considerable.
МОДЕЛЬ ФОРМУВАННЯ ГЕНДЕРНОЇ ВИХОВАНОСТІ В ПРОЦЕСІ ЖИТТЄДІЯЛЬНОСТІ ЛЮДИНИ
Authors: Криворотько Анастасія
Published: August 2023

Актуальність теми полягає у постановці питання про важливість впровадження гендерного виховання, адже саме за допомогою нього учні зможуть більш глибше зрозуміти всю структуру людських відносин, і відповідно гармонійніше побудувати свою особистість, а дорослі розібратися та позбутися застарілих стереотипів та покращити взаємозв’язок з оточуючими. Метою даної статті є розгляд та обґрунтування моделі формування гендерної вихованості в процесі життєдіяльності людини. Методи дослідження полягали у змістовному аналізі напрацювань науковців у сфері вивчення гендеру, а саме як вони описували основні поняття та їх взаємозв’язок. У результаті ми змоделювали та описали етапи формування гендерної вихованості (І – пояснення різниці між статтю та гендером; ІІ – статева та гендерна соціалізація; ІІІ – статева гомогенізація; ІV – накопичення знань щодо гендерної культури та стереотипів; V – накопичення знань щодо гендерних ролей; VІ – становлення гендерної ідентичності людини; VІІ – формування гендерної свідомості людини), а також чинники, які впливають на весь цей розвиток (соціальні, культурні, педагогічні, психологічні). У висновку, ми дійшли до думки, що гендер є динамічною та контекстуальною конструкцією, і його формування залежить від взаємодії різних факторів, таких як культура, соціальний контекст, виховання та індивідуальний досвід. А також, що на якість знань з розуміння всіх особливостей гендеру можна вплинути позитивно, наприклад, проводячи виховні заходи, щодо відповідної тематики (позбавлення стереотипів, знайомства з різними культурами, програвання різних гендерних ролей, допомога у становленні ідентичності і т.п.). Відповідно без цих заходів, людина при самостійному вивченні цих питань може затримуватись на певних етапах та довго розбиратись, і навіть знайти не вірні відповіді, які їй не допоможуть покращити життя. Отже, впровадження гендерного виховання сприятиме позитивним змінам у ставленні до гендеру, допоможе побудувати особистість на основі власних цінностей та переконань, а також сприятиме покращенню взаємин між людьми в усіх сферах життя.
«УКРАЇНСЬКА ЖЕСТОВА МОВА» - УПРОВАДЖЕННЯ НОВОГО ДЕРЖАВНОГО СТАНДАРТУ У 5-6 КЛАСАХ НОВОЇ УКРАЇНСЬКОЇ ШКОЛИ
Authors: Кульбіда Світлана , Біланова Ольга , Іващенко Лаура
Published: August 2023

Жестова двомовна освіта має важливе значення як для мовного розвитку учнів з порушеннями слуху, задоволення їхніх базових комунікативних потреб, опанування ключових компетентностей з предмету «УЖМ». Дослідження сфокусовано на розробленні і впровадженні модельних програм з УЖМ у 2022-2023 навчальному році, що є закономірним явищем з урахуванням сучасних законодавчих освітянських змін – впровадження Державного стандарту. Мовознавча галузь української жестової мови утримує можливість свого узаконеного місця в освітньому процесі загальноосвітніх спеціальних шкіл в адаптаційний період з формуванням жестомовних комунікативних компетентностей мовної особистості глухого і зі зниженим слухом учнів.
ВИКОРИСТАННЯ KWL ТАБЛИЦІ В НАВЧАННІ УЧНІВ З ПОРУШЕННЯМИ ІНТЕЛЕКТУАЛЬНОГО РОЗВИТКУ
Authors: Тороп Крістіна , Ярмола Наталія
Published: August 2023

Зміни, які сьогодні відбуваються в освіті спонукають вчителів використовувати такі методи навчання, які б максимально задовольняли індивідуальні потреби учнів з порушеннями інтелектуального розвитку, враховували їх інтереси та відповідали рівню їх здібностей. У статті зазначено важливість інноваційної діяльності закладу освіти, яка передбачає пошук та впровадження ефективних методів навчання та виховання школярів з порушеннями інтелектуального розвитку. Окреслено труднощі з якими стикаються учні з інтелектуальними порушеннями у навчанні.

Навчання учнів з порушеннями інтелектуального розвитку (ПІР) є непростим завданням. Стратегії, які вчителі використовують для навчання учнів з порушеннями інтелектуального розвитку, мають бути універсальними та гнучкими, задовольняти освітні потреби школярів та відповідати меті Державного стандарту базової середньої освіти, а саме розвивати природні здібності, інтереси, обдарування учнів, формувати компетентності, необхідні для їх соціалізації та ін.

Метою статті є розглянути можливості використання KWL таблиці в навчанні учнів з порушеннями інтелектуального розвитку. Для досягнення поставленої мети та розкриття тематики були використанні методи систематизації та узагальнення досліджуваного матеріалу.

У статті зазначено важливість інноваційної діяльності закладу освіти, яка передбачає пошук та впровадження ефективних методів навчання та виховання школярів з порушеннями інтелектуального розвитку. Окреслено труднощі з якими стикаються учні з інтелектуальними порушеннями при навчанні. Розглядається KWL стратегія, яка покликана допомагати учням розвивати навички контролю розуміння тексту та сприяє усвідомленню того, як вони можуть використовувати свої знання, щоб визначити, чому вони хочуть навчитися. Розтлумачено абревіатуру KWL. Запропоновано варіант адаптації KWL таблиці для використання в освітньому процесі школярів з порушеним інтелектом. Охарактеризовано переваги використання KWL таблиці. Розкрито можливості використання KWL таблиці в навчанні учнів з порушеннями інтелектуального розвитку, описано алгоритм роботи з нею та наведено приклади її використання.

Перспективи подальших досліджень передбачають визначення ефективності використання KWL таблиць для формування предметних та ключових компетентностей учнів з порушеннями інтелектуального розвитку.
Kidney Disease – Bangladesh Perspective
Authors: Alam Muhammad Rafiqul
Published: August 2023

In Bangladesh, most patients with Chronic Kidney Disease (CKD) are diagnosed in the advanced stages of the disease, which leads to a high demand for kidney transplantation and dialysis services.Several studies suggest prevalence rate of CKD 6–18%; of them 11% were in stage III–V.Every year 35,000-40,000 new cases of kidney failure.Every year >20,000 chronic kidney failure patients die as they cannot afford dialysis or kidney transplant.73% treatment cost is out of pocket in Bangladesh.The cost of hemodialysis per session varies from 400- 4500 BDT (USD 4-45) depending on institute.Even the ultra-poor patients who take dialysis at the rate of BDT 500 (USD 5) per session have to spend a minimum of BDT 20,000 (USD 200) per month only for the treatment cost. 40% patients discontinue dialysis after 3-4 months due to financial constraint. The existing facilities can hardly accommodate 9000–10,000 new patients, which means RRT isnot available for 70–75% of ESRD patients.Annually dialysis is done on >18,000 kidney patients across the country.80% of the total kidney-related deaths are caused due to insolvency to continue treatment.Currently >90% of dialysis patients are receiving Hemodialysis.Initiatives are taken to make CAPD more accessible, but high cost of PD fluid & lack of trained personnel remains as major barriers. Challenges are there in providing Nephrocare.There is insufficient number and uneven distribution of trained medical & allied health professionals, lack of proper referral system & follow-up & lack of laboratory facility in many areas, particularly in rural setup.Absence of insurance coverage for kidney dialysis & transplant treatment.Absence of patient support group & their participation in policy making process. To overcome the challenges we have to ensure affordable & equitable access to kidney care for people living with CKD through Public & Public Private Partnerships. Protection from out-of-pocket healthcare expenditure through universal health coverage to provide insurance coverage for CKD patients and Subsidized treatment for dialysis & kidney transplant.Expansion of Fellowship program to develop more Nephrologists & training facility/ centers to develop more allied health professionals.Facilitating research for kidney disease with technical and financial support.Improve screening to ensure timely diagnosis and prevent CKD related complications.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 179-180
Prescribing drugs in Renal Failure: A Judicious Approach
Authors: Dutta Pradip Kumar
Published: August 2023

Prescribing drugs in renal failure is essential to reduce their toxic effects due to unusual accumulation in renal failure. It is because of less protein binding and prolong half life of elimination in case of renal failure. Usually the toxicity of the drug is reduced by either diagnosing serum level of the specific drug or by measuring eGFR of the particular patient. We commonly use three methods in these cases to reduce the side effect of the drugs 1. Interval extension, 2. Dose reduction. 3. Combination of the above two. In case of patients on hemodialysis the drugs which are not protein bound are easily eliminated, so in such cases the drugs are either given after hemodialysis or giving a fraction of the individual dose just after hemodialysis. In case of Renal Transplantation prescribing drugs requires knowledge of the drug-drug interection. It is to be remembered that to get the immediate therapeutic efficacy of the drug in case of renal failure the loading dose is same as that of patients without renal failure, only the maintenance dose is either reduced or given with a prolong interval or both. The following drugs are specially important during prescribing in Renal Failure 1. NSAIDS 2. Psyhotherapeutic drugs 3. Antimicrobials and 4. Cardiovascular Drugs.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 180
Hypertension in pregnancy: challenges in the management
Authors: Sarmin Shahnoor
Published: August 2023

Pregnancy is a cardiovascular and metabolic challenge to the human female body.During pregnancy, systemic vascular resistance and blood pressure decrease, whereas cardiac output and blood volume increase to safeguard an adequate circulation in the utero-placental arterial bed.Hypertensive disorders of pregnancy affect approximately from 5 to 10% of all pregnant women, and are the main contributors of maternal and neonatal morbidity and mortality worldwide. Hypertension in pregnancy includes a wide spectrum of conditions, including pre-eclampsia and eclampsia, pre-eclampsia superimposed on chronic hypertension, chronic hypertension, and gestational hypertension. Endothelial dysfunction, oxidative stress and an exaggerated inflammatory response are features related to hypertensive disorders. To reduce the risk of maternal and foetal complications due to haemodynamic maladaptation, the current management includes rest at home or in the hospital, closes monitoring of maternal and foetal signs and symptoms, early start of antihypertensive therapy, and timely delivery regarding maternal and foetal survival chances. Thresholds to initiate blood pressure lowering treatment during pregnancy are 160 mmHg systole or 110 mmHg diastole. Below these thresholds, treatment must be individualized because current evidence does not support aggressive medical interventions. Alpha-methyldopa and dihydropyridine calcium channel blockers are among the recommended antihypertensives. The major goal is to prevent maternal complications without compromising uteroplacental perfusion and fetal circulation. Before an antihypertensive agent is prescribed, the potential risk to the fetus from intrauterine drug exposure should be carefully reviewed.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 186
Acute pancreatitis: Early Management
Authors: Kibria Md Golam
Published: August 2023

Abdominal pain caused by acute pancreatitis (AP) is not uncommon in day to day medical practice worldwide. AP is the sudden inflammation of the pancreas, and it may be confined to the pancreas, or may be more life-threatening, affecting all organs and systems. It progresses mildly in 80% of patients and resolves with treatment, but in cases of severe AP, with mortality of around 30% has been recorded. AP is most often established by clinical symptoms and at least threefold raised enzymes and by imaging (any two of these three).In the management AP, treatment is mainly related to the severity of the disease and approaches are constantly being updated. With early diagnosis and treatment, most of the patients can be discharged, and the development of complications and mortality can be reduced. Hemodynamic status should be assessed immediately upon presentation and resuscitative measures begun as needed. Early targeted fluid therapy within the first 48 h is critical to improve the outcome of severe AP. Patients with organ failure and or SIRS should be admitted to an ICU /HDU whenever possible. Emergency management decision are early fluid management strategy, utility and timing of antibiotics, the timing and type of nutritional support and in relevant cases endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy approachescan change the course of the disease and the length of stay in the hospital. Therefore, emergency management is important.Enteral nutrition is recommended to prevent infectious complications, whereas parenteral nutrition should be avoided.Routine use of prophylactic antibiotics in patients with severe AP and or sterile necrosis is not recommended.In patients with infected necrosis, antibiotics known to penetrate pancreatic necrosis may be useful in delaying intervention, thus decreasing morbidity and mortality. Successful clinical management requires close interdisciplinary cooperation and coordination from experienced gastroenterologists, intensive care physicians, surgeons, and radiologists.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 188-189
Challenging Thyroid Cases in Clinical Practice
Authors: Saifuddin M
Published: August 2023

Thyroid disorders are prevalent, and their manifestations are divergent and sometimes it is very challenging to diagnose and deal with some Thyroid cases in clinical practice. Here seven different challenging cases will be discussed that will help clinicians to diagnose and treat such cases in dayto- day clinical practice. First case enlightened us that Thyroid function should not be assessed in seriously ill patients unless there is a strong suspicion of thyroid dysfunction, since there are many other factors in acutely or chronically ill euthyroid patients that influence thyroid function tests. The second case taught us that there is assay interference with Biotin ingestion and patients taking Biotin should hold the supplement for two days prior to assessing thyroid function. Subacute thyroiditis is a self-limiting inflammatory condition of the thyroid gland and COVID-19 virus infection may be associated with subacute thyroiditis as a complication that may occur in patients without any previous thyroid disorder that is revealed in third case. In Secondary hypothyroidism/Hypopituitarism, TSH may be low, normal, or even slightly elevated due to inactive TSH isoform in blood. The fourth case shows us that only TSH testing in clinical practice leads to missing Secondary hypothyroidism/Hypopituitarism. Learning from fifth case is that during monitoring of thyrotoxic patients taking ATDs, serum TSH may remain suppressed for several months after starting therapy and it is therefore not a good parameter for monitoring therapy early during treatment, rather we should rely on FT4 and FT3. The sixth case enlightened us that in case of low TSH in early pregnancy, Gestational transient Thyrotoxicosis should be excluded which is commonly associated with hyperemesis gravidarum with no prior history of thyroid disease, no stigmata of Graves’ disease (Goiter, ophthalmopathy) and a self-limited mild disorder. In poorly compliant patients, there may be a combination of high FT4 and high TSH that is revealed in the seventh case.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 189
Bone Marrow Transplantation: Pre and after care
Authors: Karim Md  Mostafil , Mahfuz Huque , Uddin Mohammed Mosleh , Khan Abul Kashem , Akhter Shahina
Published: August 2023

Worldwide, Hematopoietic stem cell transplantation is one of the curative options of treatment for hematological malignancies and other hematological diseases. In few recent years, in Bangladesh, Hematopoietic stem cell transplantation (HSCT) has started and improved significantly, especially in patients with hematological malignancies & nonmalignant hematological diseases. As one of the leading BMT Center, CMH Dhaka has started BMT 8 years ago with the successful case of Allogeneic Bone Marrow Transplantation (Allo-HSCT) which was first time in Bangladesh. It was a historic event and landmark achievements in the history of Medical Science of Bangladesh as Allo-HSCT Bone Marrow Transplantation comparatively have a higher risk of life-threatening complications than Auto-HSCT. Till date, Dhaka CMH BMT Center has successfully completed 65 Bone Marrow Transplantation (48 Auto- HSCT & 17 Allo-HSCT). It is an amazing milestone and advancement in medicine of Bangladesh. A series of tests (Like-Hematological profile, Extensive infection screening, Heart function test, Lung function test, Bone Marrow Study, Bone density scan, PET-scan, CT-scan, Chest X-ray, HLA Typing etc.) and procedures can assess general health and the status of patient‘s condition. The tests and procedures also ensure that patient is physically prepared for the transplant. The evaluation may take several days or more. In the days and weeks after bone marrow transplant, BMT specialists do blood tests and other tests to monitor patient‘s condition. They may need medicine to manage complications, such as nausea and diarrhea. After bone marrow transplant, the patient remains under close medical care. If a patient experiencing infections or other complications, he/ she may need to stay in the hospital for several days or longer for close monitoring. Patients may need periodic transfusions of red blood cells and platelets until bone marrow begins producing enough of those cells on its own. Patient needs follow up and Transplant Physician supervision till death.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 191
Childhood obesity: Sequelae in adult life
Authors: Begum Suraiya
Published: August 2023

Childhood obesity is a growing global health hazard extending to adulthood. The prevalence of obesity in children in developed and developing countries has risen dramatically in the past few decades and is currently at epidemic proportions. Obese children and adolescents were around five times more likely to be obese in adulthood than those who were not obese. Adiposity rebound in early childhood is a risk factor for obesity in adolescence and adulthood. Numerous sequelae are associated with children being overweight or obese, even at a very young age. Obesity in childhood and adolescence is significantly associated with an increased risk of insulin resistance, type 2 diabetes mellitus, dyslipidemia, hypertension, metabolic syndrome, non-alcoholic fatty liver disease, and obstructive sleep apnea. Obese children are more likely to experience psychological morbidity, lower self-esteem, and more behavioral problems than non-obese children. These comorbid conditions may progress to adult life and the development of atherosclerosis, cerebrovascular disorders, and cardiovascular morbidity later in life. Obese children are more likely to become obese adults and suffer lifelong physical and mental problems and risk of premature mortality. The use of infant formula, decreased physical activity, excessive calorie intake, and changes in gut microbiota patterns are associated with the increasing prevalence of childhood obesity. Efforts will be focused on trying to treat obesity itself and, therefore, prevent progression to overt sequelae, either in childhood or later in adult life. The most important strategy for preventing obesity and sequelae is lifestyle modification which includes healthy eating behaviors, regular physical activity, and reduced sedentary activity.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 191-192
Laser Therapy in Dermatology: Hopes or Hype?
Authors: Mahmud Md Mostaque
Published: August 2023

Laser therapy is a newly adopted surgical option in Dermatology. Targeted photo-thermolysis with minimal injury to the surrounding tissue is the principle of laser therapy. It became popular in affluent society for its aesthetic use. Regarding rejuvenation, pigmented lesions, and unwanted hair removal laser therapy is superior to other available options. Laser therapy is an excellent option for vascular lesions like hemangioma, telangiectasia, and port wine stain. The most commonly used laser is CO2laser. It can be used to ablate growth and resurface scars and wrinkles. The advantages of laser therapy over conventional surgery are less chance of bleeding, scarring, and infections. Laser therapy is a unique option for tattoo removal. In many dermatological diseases, laser therapy shows some glimpses of light where other options failed. In every aspect laser therapy is a modern smart way to treat skin problems. But it is costly and not reachable to common people. There is a false belief in patients that lasers can cure all skin diseases. Practically a minor portion of skin diseases can be managed by laser therapy. Only laser cannot change your skin according to your expectation rather you need filler, botulinum toxin, chemical peel, medications, and sometimes plastic surgery along with laser therapy.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 193
Sepsis: Current Concepts
Authors: Nuruzzaman Md
Published: August 2023

Sepsis is a life-threatening syndrome caused by an exaggerated host immune response to infection. Despite advances in diagnosis and treatment, sepsis remains a major global health concern, with significant morbidity and mortality rates. Current concepts in sepsis management emphasize the need for early recognition and treatment of the condition, with a focus on the optimization of fluid resuscitation, antibiotic therapy, and supportive care. Recent studies have shown that a multifaceted approach to sepsis management, involving a combination of pharmacological and non-pharmacological interventions, may improve outcomes. This approach includes the use of biomarkers for early diagnosis, goal-directed therapy to optimize resuscitation, and the implementation of protocols for timely initiation of appropriate antimicrobial therapy. Furthermore, recent studies have highlighted the importance of individualized patient care in sepsis, with a focus on tailoring treatment to the specific needs of the patient. There is also growing interest in the use of novel therapies for sepsis, such as immunomodulatory agents, extracorporeal therapies, and stem cell therapies. These therapies have shown promising results in preclinical studies, and may provide new avenues for the treatment of sepsis in the future. Overall, the current concept of sepsis management emphasizes early recognition and intervention, individualized patient care, and a multifaceted approach to treatment. Further research is needed to identify optimal approaches to sepsis management and to develop novel therapies for this complex condition.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 195
Approach to multidrug resistant bacterial infections
Authors: Basher Ariful
Published: August 2023

Several bacterial pathogens have evolved into multidrug resistant (MDR) forms both in developed and developing countries at an expanding rate. The World Health Organization has identified antimicrobial resistance as one of the three most important problems facing human health. It was estimated that 4·95 million deaths were associated with bacterial AMR globally in 2019.1 Three infectious syndromes dominated the global burdens attributable to AMR: lower respiratory and thorax infections, bloodstream infections, and intra-abdominal infections. Some of the most important MDR pathogens that currently cause infection in hospital and in the community are the so-called “ESKAPE” pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, and Enterobacter species), emphasizing their capacity to “escape” the effects of routine antibiotics. Most of the MDR studies were heterogeneous in terms of study design, patient population, site of infection, choice of antibiotic treatment, duration of followup period, and the outcome definitions, making it difficult to compare the different treatments and combinations of antibiotics used. Current recommendations in Europe and USA are based on systematic reviews that suggest different methods to prevent and control MDR infections, but provide little data on new and alternative antibiotic treatment options and therefore provide little firm guidance on specific treatment choices and algorithms. Attempts are ongoing to overcome antibacterial resistance by using new agents and combinations of new plus old agents. For example, both old (clavulanic acid, tazobactam) and new (avibactam, vaborbactam, relebactam) BLIs are being used in treatment algorithm for critically ill patients in the ICU according to MDR pathogen. There were still controversies regarding microbiological success for single agent compared with combinations of multiple agents. Many bacteria have the ability to produce biofilms, comprising organized congregations of bacteria adhering to each other making complex condition where antibiotic failed to wipe out bacteria despite of retaining in vitro susceptibility. It is also not always possible to conduct randomized controlled studies involving the required number of patients in a timely manner. So a requirement with the increasing choice of highly effective antimicrobial drugs, with dosages based on pharmacokinetic analysis of drug disposition, selection of the appropriate drug based on clinical microbiological data and pharmacodynamic indices. Rational antimicrobial therapy is more applicable today than in the history of antimicrobial therapy. Exploring newer modalities such as phage therapy and lytic antibiotics as well as obtaining a deeper understanding of the pathways involved in MDR mechanisms in order to engineer targeted drugs. Besides, rapid and comprehensive diagnostics are the key factor for the future management of antimicrobial resistance.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 195-196
Short-term of mortality in acute stroke patients
Authors: Mondal Ratindra Nath , Barman Susanto , Jamal Mahajabin , Rani Moni , Jahan Shah Md sarwer , Hussain Muhammad Mahbub , Sarker Md kumruzzaman , Rahman Md Mahfuzer , Islam Md Atiqul , Hossain Md Zakir
Published: August 2023

Background: Stroke is a major cause of disability and death. A significant number of patients with acute stroke dies within 30 days of developing stroke. The aim of the study was to determine the short-termmortality (within 30 days) in acute stroke patients.
Methods: This was a cross-sectional study, carried out in the Department of Medicine of Rangpur Medical College Hospital. Date was collected for 6 months (from January to June).
Results: During the study period, we studied of 248 acute stroke patients, among them 110 were hemorrhagic and 138 were ischemic. Mean age of the patients were 56.02 years in hemorrhagic stroke and 61.26 years in ischemic stroke. In case of hemorrhagic stroke, short term mortality was 45.5% (50), among them in hospital death was 88% (44) and majority of the deaths occurred with in the first 7 days. Mortality was significantly higher among patients with larger hematomas (>60 cm3) compared to subjects with smaller hematomas (<30 cm3). Short term mortality was 18.1% in ischemic stroke. Infarction size more than 10 mm2, total anterior circulation syndrome (TACS) and GCS less than 10 at presentation were significantly associated with short term mortality.
Conclusion: Short-term mortality was high in acute hemorrhagic stroke than acute ischemic stroke. In hemorrhagic stroke larger hematoma, GCS at presentation, ventricular extension and in case of ischemic stroke size of the infarction, arterial territory involvement and GCS were predictor of mortality.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 205
Role of Serum CA 125 Level in the Diagnosis of Pulmonary Tuberculosis
Authors: Shafiujjaman ASM
Published: August 2023

Background: Pulmonary tuberculosis (PTB) persists as a great public health problem in Bangladesh. Although many diagnostic tools are invented but the diagnosis continues to rely on smear microscopy, culture and chest radiography. Other non-conventional approaches include detection of immunological response and the search for biochemical markers. Cancer Antigen 125 (CA-125) was considered a promising one and have been reported in few instances.
Methods: This study was a hospital based cross-sectional analytical study conducted at department of Medicine in Rangpur Medical college Hospital, Bangladesh for 24-months following approval of the protocol. Total 100 people with pulmonary tuberculosis either smear positive or smear negative gene X pert positive were selected and analysed in this study. Written informed consent were taken from all subjects. After taking written consent from each patient, detailed clinical history, physical examination and relevant investigations including serum CA 125 level were done for every patient. Reflection of CA 125 positivity were calculated on the basis of smear positive and smear negative gene X pert MTB/RIF positive pulmonary tuberculosis. Collected data were noted down in separate case record form. After removing consistency and compilation, final data analysis was done in the statistical program Statistical Package for Social Science (SPSS) version 23.0.P-value of <0.05 was considered to indicate statistical significance.
Results: Of total 100 patients, mean age was 36.68 ± 12.57 SD (years) with slight male predominance with Male female ratio was 2.13:1. Overall elevated CA-125 was found in 88% cases with mean value 90.82 ± 74.28 IU/mL. Mean level of CA- 125 among sputum smear positive cases 74.69±49.51 IU/mL (37-153 IU/mL). Among 50 smear negative gene Xpert positive cases, 24% had serum CA-125 level <35 IU/mL (19.73±11.86 IU/mL) and rest 76% had e”35 IU/mL (134.51±86.74 IU/mL). Smear negative & gene Xpert positive cases has statistically significant higher level of CA-125 cases in comparison to smear positive cases (P-value <0.05).
Conclusion: More than two thirds of the pulmonary tuberculosis patients had higher level CA-125 and smear negative-Xpert positive cases had significantly higher level than smear positive cases.
Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 206
Ta'zir (Punishment) at Islamic Boarding Schools; Between Tradition, Conception, and Shadows of Human Rights Violations
Authors: Rahmatullah Asep , Baharun Segaf
Published: August 2023

This article examines the practice of Ta'zir, a form of discretionary punishment, within the context of Islamic boarding schools. Ta'zir holds a significant place in Islamic jurisprudence, allowing authorities to determine penalties for offenses not explicitly addressed in religious texts. However, the application of Ta'zir has raised concerns, particularly in the context of Islamic boarding schools, where traditional practices intersect with modern notions of human rights. Drawing upon a multi-disciplinary approach, this study delves into the historical, cultural, and religious aspects of Ta'zir, elucidating its evolution from its inception to its current manifestations within Islamic boarding schools. By analyzing primary sources, legal texts, and case studies, the article underscores the diverse interpretations of Ta'zir and its malleability in adapting to contemporary circumstances. Furthermore, the article critically evaluates the potential conflicts between the traditional practice of Ta'zir and international human rights standards. It examines instances where Ta'zir punishments might be perceived as infringing upon human dignity, bodily integrity, and freedom from cruel, inhuman, or degrading treatment. The study also explores the role of Islamic boarding schools in shaping and perpetuating these practices, considering the interplay between religious education, discipline, and the protection of children's rights. The findings of this research reveal a complex landscape where tradition clashes with modern sensibilities. The article advocates for a nuanced dialogue between religious scholars, educators, and human rights advocates to strike a balance between preserving cultural heritage and upholding universally recognized human rights. It highlights the importance of reinterpretation and contextualization of Ta'zir in line with the principles of justice, mercy, and human dignity as emphasized within Islamic teachings. In conclusion, this article contributes to the ongoing discourse on the compatibility of traditional Islamic practices with contemporary human rights frameworks. It calls for a thoughtful reevaluation of Ta'zir within Islamic boarding schools, promoting an inclusive approach that safeguards both religious heritage and fundamental human rights.
Breaking the Dullness of Thought Among Nahdliyin: The Genealogy of KH. Sahal Mahfudh's Civilization Jurisprudence
Authors: Asofik Mohammad Rifâ€™an , Khafidh Ahmad
Published: August 2023

This article discusses the central role of the KH. Sahal Mahfudh as a breaker of thought dullness among Nahdliyin through a genealogical approach to the jurisprudence of civilization. Nahdlatul Ulama (NU), one of the largest Islamic organizations in Indonesia, plays a significant role in shaping the religious identity and civilization of society. However, like other organizations, NU also face challenges in the face of rapid social, political, and technological changes. KH Sahal Mahfudh, a renowned scholar and NU leader, became a key figure who carried out the mission of renewing the understanding of jurisprudence among Nahdliyin. This article describes the genealogy of jurisprudence thought among Nahdliyin since the beginning of NU to KH. Sahal Mahfudh's role as a pioneer in reviving and renewing scientific discourse within the NU. Through the genealogy analysis method, this article traces the origins of jurisprudence in Nahdliyin and examines its development from time to time. The results show that over time, jurisprudent thinking among Nahdliyin tends to experience stagnation, especially in dealing with contemporary issues. This poses a challenge to answering the problems of Islamic laws that are relevant to the context of the times. KH Sahal Mahfudh, with his progressive and inclusive vision, succeeded in offering a jurisprudent approach that is relevant and adaptive to changing times. Through his work, he invited Nahdliyin to re-explore the roots of authentic Islamic science, while still paying attention to the context of modern civilization. KH. Sahal Mahfudh's important contribution to developing scientific discourse among Nahdliyin helped unravel the stagnation of thought and paved the way for the continuous renewal of Islamic thought. Thus, this article provides insight into the importance of the renewal of thought among Nahdliyin, especially in the context of modern civilization. The genealogy of civilization jurisprudence is described through the role of KH. Sahal Mahfudh provided a valuable contribution to understanding the dynamics of Islamic thought in Indonesia, as well as its relevance in facing various contemporary challenges.