Background: Change of voice is one of the common complaints in ENT practice and hoarseness of voice is the commonest symptom of changed voice quality. Hoarseness is invariably the earliest manifestation of conditions directly or indirectly affecting the voice apparatus. Though most common causes of hoarseness are benign and vocal abuse is the commonest among them, but we should always investigate for more sinister pathology like malignancy. Objectives: To find out the symptoms, signs and pathological incidence, leading to change of voice for early diagnosis and interventional purpose. Methods: Total 87 patients of change of voice, studied in 06 months duration from 1st January 2016 to 30th June 2016 in the Department of ENT & Head-Neck Surgery, Dhaka Medical College Hospital, Dhaka. The cases were selected according to the eligibility criteria by purposive sampling. Then the data were collected by the active participation of the patients interviewed by the preformed proforma of data collection sheet. Results: Maximum number of cases of change of voice were due to carcinoma larynx (37.93%), then chronic laryngitis (20.99%), followed by vocal cord nodules (19.54%) and vocal cord polyps (8.05%.). Laryngopharyngeal reflux was found in 45.95% patients of chronic laryngitis. Males were affected more than females (1.81:1). Most of the patients were in the age group of 21 to 50 years. Peak incidence was in the 4th decade. Labourers/ daily wage earners formed the predominant group. Majority of patients were from low socioeconomic class. Smoking, vocal abuse, smoking and infections were the common predisposing factors. Conclusion: Hoarseness of voice is just a symptom with a very diverse etiology. The etiological data varies in different geographical location and from one center to other, so every case should be carefully and thoroughly evaluated to know the diagnosis and underlying pathology for early and prompt management. J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 116-125

an operation was performed-allograft of a donor kidney (donor is the patient's sister), however, a month later an early allograft rejection was noted. The results of a molecular genetic study from 21.08.2013 at the Mayo Clinic Hyperoxaluria Center (USA) revealed mutation 1: c.33_34insC, p.P11fs33X, mutation 2: c.33_34insC, p.P11fs33X, which corresponds to type I hyperoxaluria. In the spring of 2014, the patient was treated at the Fortis Memorial Research Institute clinic (Gurugram, India), and on 20.08.2014 despite the indication of immunogenetic data and the need for kidney and liver transplantation, a second kidney transplantation was performed in a hospital in India (donor is the father of the child) The postoperative period proceeded with complications. The patient was discharged from a clinic in India to continue treatment at the place of residence. In admission to the Center of Nephrology and ECDofUC, the condition was regarded as very severe due to multiple organ failure, decompensation of all vital functions, due to the progression of type 1 hyperoxaluria. Despite ongoing therapeutic measures, the child died. Cause of death: Progressive multiple organ failure: cardiovascular failure, respiratory failure, renal failure. Conclusions: The leading manifestations of primary type 1 hyperoxaluria in this case were: the development of ESRD with urolithiasis, kindred marriages, cases of urolithiasis with a terminal outcome in the family, data from a molecular diagnostic study revealing a characteristic gene mutation. Early diagnosis, simultaneous liver and kidney transplantation optimizes the prognosis for this pathology.

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A major role of cost model is to ensure that the resource being handled is maintainable, functional and secure. The last decade has shown that attention to the idea of cost model added value to accomplish this management. In the context of cost model research and practice, the purpose of this paper is to identify, compare and describe the different cost models and investigate their value parameters. A systematic literature review of various publications has been followed in order to categorize the different theoretical models and to analyze the key quality parameters in the cost model. The established eight theoretical models were described in the sense of cost and the variant research projects and structures have taken into account very diverse parameters. In cost models, this analysis organizes 11-various quality parameters into four relevant headings: individuals, system and material, economy and social. Among all value parameters, cost reduction and customer satisfaction, followed by efficiency, are the most prioritized value parameters. This paper results provide a sound basis and realistic interpretation of future research to harmonize the definition of cost model added value as it is based solely on literature review.