doi:10.3329/jafmc.v4i2.1845 JAFMC Bangladesh Vol.4(2) 2008 38-41

DOI = 10.3329/jom.v9i2.1440 J MEDICINE 2008; 9 : 105-107

Visceral leishmaniasis (kala-azar) continues to be a major rural public health problem in Bangladesh. A cross-sectional study was carried out in two subdistricts of Mymensingh district from January 2006 to June 2007 to evaluate the delay kala-azar treatment. Suspected patients who attended to out patient department (OPD) were subjected to a dipstick test (RK39) for kala-azar. Sixty five from Bhaluka and 60 positive patients from Gafargaon subdistrict were enrolled. Most of the patients (80%) first visited nonqualified private practitioners, while only 15.2% consulted registered doctors. Fifty per cent were referred to the Upazilla health complex (UZHC) by the family members or relatives. About 49% and 43% patients required third and second health-care providers for kala-azar treatment, respectively. Patient delay ranged from 2 to 30 days; median 4 (IQR 3 to 7 days), the system delay ranged from 0 days to 225 days; median 54 (IQR 40-66 days). Residential status (p value <0.05) had impact on patient delay. Educational status and number of treatment providers had impact on system delay (p<0.05). System delay rather than patient delay is the important weakness of the kala-azar control programme in Bangladesh. Residence in rural areas, low educational background and treatment providers are associated with these delays. A proper educational programme may reduce the delay.

Background and Aim: The renal stones of any size could be effectively managed through an essential surgical technique known as Percutaneous Nephrolithotomy (PCNL). The large size renal stones with abnormal kidneys imposed additional challenges for PNCL in anomalous kidneys. The present study aimed to evaluate the effectiveness and safety of Percutaneous Nephrolithotomy in malrotated kidneys. Place and Duration: Conducted at Urology department of Mian Gul Abdulhaq Jehanzeb Kidney Hospital Manglawar, Swat for duration of two years (from May 2019 to April 2021). Materials and Methods. This single-centered retrospective study was conducted on 80 patients who underwent percutaneous nephrolithotomy with malrotation kidneys. The individuals with anomalous kidneys and complex calculi were enrolled in this study. These patients had kidneys anomalies such as horseshoe kidneys, crossed fused ectopia, malrotation kidneys, pelvic and complete stone clearance. Posterior or anterior approaches were followed for the procedure after preoperative evaluation in kidney anomalies. Retrograde catheterization was carried out under spinal and general anesthesia with the patients. For all the patients, stone size and clearance were measured. Results: Of the total 80 kidneys anomalies patients, 55 (68.7%) were male and 25 (31.3%) were females. Overall mean age was 35.26 ± 13.51. The stone size varied from 1.3cm to 7 cm. Patients were categorized into two groups based on stone sizes such as group I (1.3-2.5 cm) had 42 (52.5%) and group II (25-7cm) 38 (47.5%) patients. The patients included renal pelvis 19 (23.6%), the pelvic ureteric junction (PUJ) 8 (10%), horseshoe kidneys 2 (2.5%), crossed fused ectopia 9 (11.3%), and malrotation kidneys 3 (3.8%).The stone clearance was completed in 77 (96.3%) patients. The statistically significant factor for complete clearance was the staghorn stone calculus. Conclusion: Percutaneous nephrolithotomy is a safe and effective procedure for large renal stones management in patients of anomalous kidneys. Higher renal stones clearance can be achieved with minimum morbidity by suitable preoperative evaluation and technical experts. Keywords: Malrotated kidney; Nephrostomy, Percutaneous; Nephrolithiasis; Abnormality

Objectives: Effective implementation of mathematical and statistical modelsmaximizes the likelihood of understanding the trajectory, level and pattern of incurable diseasesand their therapies, so that precise demand strategies for costly lifesaving therapies for future,resource allocation and timely intervention could be ensured, a significant concern for lessdeveloped countries like Pakistan. Methods: The record of monthly number of patients onlifesaving anti-Retroviral Therapy for more than 18 HIV treatment centers in Pakistan wasacquired for the period January 2011 to July 2013.A set of eleven curve fitting models namelylinear, quadratic, cubic, logarithmic, inverse ,exponential growth model, logistics-curve andcompound models was carried out for prediction. Results: After the execution of various curvefitting models by taking the ANOVA approach along with coefficient of determination and theforecast accuracy measures namely, mean percentage error (MAPE), mean absolute error(MAE) and mean square error (MSE) in the selection of final efficient model. Cubic model wasselected for forecasting the monthly anti-retroviral therapy cases for all categories i.e. overall,male female and children. On the basis of final selected model 3% increment is expectednumber of paticuts on anti-retroviral therapy annually in HIV treatment center in all Pakistan.Male patients are expected to increase 14% who will get lifesaving anti-retroviral therapies.While the annually expected reduction of 17% and 42% in female and children cases takinganti-retroviral therapy is expcted in future respectively. Conclusions: The overall number ofpeople on anti-retroviral therapy are expected to increase in Pakistan. Males are expected tohave greater risk as compared to female and children in Pakistan.