BackgroundEarly start of enteral feeding is an established treatment strategy in intubated patients in intensive care since it reduces invasive bacterial infections and length of hospital stay. There is equipoise whether early enteral feeding is also beneficial in non-intubated patients with cerebral malaria in resource poor settings. We hypothesized that the risk of aspiration pneumonia might outweigh the potential benefits of earlier recovery and prevention of hypoglycaemia.Method and FindingsA randomized trial of early (day of admission) versus late (after 60 hours in adults or 36 hours in children) start of enteral feeding was undertaken in patients with cerebral malaria in Chittagong, Bangladesh from May 2008 to August 2009. The primary outcome measures were incidence of aspiration pneumonia, hypoglycaemia and coma recovery time. The trial was terminated after inclusion of 56 patients because of a high incidence of aspiration pneumonia in the early feeding group (9/27 (33%)), compared to the late feeding group (0/29 (0%)), p = 0.001). One patient in the late feeding group, and none in the early group, had hypoglycaemia during admission. There was no significant difference in overall mortality (9/27 (33%) vs 6/29 (21%), p = 0.370), but mortality was 5/9 (56%) in patients with aspiration pneumonia.ConclusionsIn conclusion, early start of enteral feeding is detrimental in non-intubated patients with cerebral malaria in many resource-poor settings. Evidence gathered in resource rich settings is not necessarily transferable to resource-poor settings.Trial RegistrationControlled-Trials.com ISRCTN57488577

This paper tries to represent the difference between single diode and two diode photovoltaic models in terms of efficiency simulated by MATLAB. The research activities done earlier had shown a clear preview that the solar cell can act as concentrated solar cell for increasing the conversion efficiency to a great extant so that output power can be improved to a large scale. Here for showing the manner of concentrated solar action double diode model has been calculated for observing the power difference in comparison with the solar cell of single diode as a convenient one. It has been observed that the photovoltaic module with two diode model is observed as highly efficient in comparison with single diode model. And this two diode model can be treated as highly efficient to convert the solar energy in the electric energy. Also, the behavior of power performance is observed practically which is included in this paper. And finally, a comparison has been drawn out to exhibit the verification of power performance for two diode model using MATLAB simulation. The mostly impact factors considered in this paper are solar irradiance and temperature affecting the power output from PV module.

Background: Early start of enteral feeding is an established treatment strategy in intubated patients in intensive care since it reduces invasive bacterial infections and length of hospital stay. There is equipoise whether early enteral feeding is also beneficial in non-intubated patients with cerebral malaria in resource poor settings. We hypothesized that the risk of aspiration pneumonia might outweigh the potential benefits of earlier recovery and prevention of hypoglycaemia. Method and Findings: A randomized trial of early (day of admission) versus late (after 60 hours in adults or 36 hours in children) start of enteral feeding was undertaken in patients with cerebral malaria in Chittagong, Bangladesh from May 2008 to August 2009. The primary outcome measures were incidence of aspiration pneumonia, hypoglycaemia and coma recovery time. The trial was terminated after inclusion of 56 patients because of a high incidence of aspiration pneumonia in the early feeding group (9/27 (33%)), compared to the late feeding group (0/29 (0%)), p = 0.001). One patient in the late feeding group, and none in the early group, had hypoglycaemia during admission. There was no significant difference in overall mortality (9/27 (33%) vs 6/29 (21%), p = 0.370), but mortality was 5/9 (56%) in patients with aspiration pneumonia. Conclusions: In conclusion, early start of enteral feeding is detrimental in non-intubated patients with cerebral malaria in many resource-poor settings. Evidence gathered in resource rich settings is not necessarily transferable to resource-poor settings.

Abdominal pregnancy is a very rare form of ectopic pregnancy with very high morbidity and mortality for both mother and fetus. A 29 years old Bangladeshi woman presented from a rural area to Chittagong medical college hospital for first gynecological evaluation after 36 weeks of amenorrhea and lower abdominal pain. An ultrasound revealed a live fetus with sub amniotic collection and possibility of ruptured uterus. Laparotomy was done and a live fetus weighing 2500 gm was delivered. Placenta was adhered with both GIT and bladder. Placenta kept in situ and injection MTX given postoperatively. After re-laparotomy for postoperative pelvic abscess and hemoperitoneum, placental tissue removed and hemostasis maintained. Both mother and fetus are discharged in good health. A live fetus can be delivered after an advanced abdominal pregnancy. Whether the placenta should be kept in situ or removed, it is controversial. After medical literature review, we propose a management in this regard. Advanced abdominal pregnancy is extremely rare diagnosis and requires a high index of suspicion. The life-threatening complication is bleeding from the detached placental site. Placenta should be kept in situ to avoid intraoperative bleeding. Placenta involution during follow-up can be revealed by ultrasound, color Doppler and β-HCG serum level decrease.

Although labour is considered as a normal physiological process, it can produce significant pain, requiring appropriate pain management. A painful labour also had detrimental effects on the mother and fetus. Ideal labour analgesia technique should dramatically reduce the pain of labour, while allowing the parturient to actively participate in birthing experience and have minimal adverse effects on the fetus and progress of labour. Epidural analgesia and opioids are often used for management of labour pain. Epidural analgesia is an effective method for managing labour pain. Studies have indicated that the procedure has few contraindications and few side-effects. The study was done to see the efficacy and safety of epidural analgesia with conventional analgesia (Inj. Pethidine and phenergan) during labour. In this study, pregnant women with active labour (Cervical dilation 4cm) were grouped into two A & B. Group A received epidural analgesia (0.125% Bupivacaine & 50 microgram Fentanyl) & group B received conventional analgesia (Inj. Pethidine & phenergan). Then the subjects were followed up and outcomes were recorded in a preformed data collection sheet. All data were analyzed by computer based software SPSS version 15. The study demonstrated a significantly earlier onset of effective analgesia in epidural group than that in the conventional group. The pain score at onset of analgesia and at different time intervals following induction and at the time of delivery were appreciably lower in women receiving epidural analgesia than those receiving conventional analgesia (p<0.001). There was no significant difference between epidural and conventional groups in terms of complications like nausea and/or vomiting (p=0.431), prolonged 2nd stage of labour (p=0.127), mode of delivery (Normal / Instrumental / Cesarean) (p=0.455). Neonatal outcome was evaluated in terms of APGAR score at 1& 5 minutes of birth in both groups which showed no significant differences (p=0.401and p=0.536 respectively). So, epidural analgesia is an effective analgesia during labour. JCMCTA 2016 ; 27 (2) : 12 - 17