A reliable estimate of the quantity of solid waste generation in the city is very important for proper solid waste planning and management. However, reported estimates of solid waste generation vary widely and lead to questionability. The reported values have been derived on the assumption of demography, standard rate of waste generation by households, density values, number of trucks engaged for waste transportation and monitoring of truck movement at dump sites, etc. This diverse nature of the available data and the question of accuracy necessitate a rigorous study that has tried to document the waste quantity in the recently formulated master plan of Dhaka City. The socio-economic parameters, behavioral characteristics, generation sources, seasonality, and per capita growth rate are considered in estimating the waste quantity along with its future projections. The findings from the estimation of waste quantities state that seasonal differences in the municipal solid waste stream are not substantial. The most seasonably variable material in the municipal solid waste stream is food waste. Residential waste is relatively homogeneous. Although there are some differences in waste generation depending on demographic and other local factors, most households dispose of essentially similar types of wastes. Variation occurs in waste composition dependent upon income levels and category of sources. Variation also occurs based upon the extent of source reduction and recycling opportunities. As opportunities exist to recycle wastes, the recycling facilities might have to grow at a similar pace to the generation of waste. Physical and chemical characteristics of solid waste are important to implement the waste disposal and management plan for the selection of resource and energy recovery potentials. A number of studies have been conducted to determine the composition of wastes including moisture content and calorific value. The data show that the moisture content in city waste is significantly higher and the calorific value is much lower, which determines the viability of composting or anaerobic digestions rather than waste combustion.

BackgroundTissue plasminogen activator (tPA) is used emergently to dissolve thrombi in the treatment of fulminant pulmonary embolism. Currently, there is a relative contraindication to tPA in the setting of traumatic or prolonged cardiopulmonary resuscitation > 10 minutes because of the risk of massive hemorrhage.MethodsOur single-center, retrospective study investigated patients experiencing cardiac arrest (CA) secondary to pulmonary embolus. We compared the effectiveness of advanced cardiac life support with the administration of tPA vs. the standard of care consisting of advanced cardiac life support without thrombolysis. The primary endpoint was survival to discharge. Secondary endpoints were return of spontaneous circulation (ROSC), major bleeding, and minor bleeding.ResultsWe analyzed 42 patients, of whom 19 received tPA during CA. Patients who received tPA were not associated with a statistically significant increase in survival to discharge (10.5% vs. 8.7%, P = 1.00) or ROSC (47.4% vs. 47.8%, P = 0.98) compared to the control group. We observed no statistically significant difference between the groups in major bleeding events (5.3% in the tPA group vs. 4.3% in the control group, P = 1.00) and minor bleeding events (10.5% in the tPA group vs. 0.0% in the control group, P = 0.11).ConclusionThis study did not find a statistically significant difference in survival to discharge or in ROSC in patients treated with tPA during CA compared to patients treated with standard therapy. However, because no significant difference was found in major or minor bleeding, we suggest that the potential therapeutic benefits of this medication should not be limited by the potential for massive hemorrhage. Larger prospective studies are warranted to define the efficacy and safety profile of thrombolytic use in this population.

Currently, no guidelines have been established for the treatment of atrio-esophageal fistula (AEF) secondary to left atrial ablation therapy. After comprehensive literature review, we aim to make suggestions on the management of this complex complication and also present a case series. We performed a review of the existing literature on AEF in the setting of atrial ablation. Using keywords atrial fibrillation, atrial ablation, fistula formation, atrio-esophageal fistula, complications, interventions, and prognosis, a search was made using the medical databases PUBMED and MEDLINE for reports in English from 2000 to April 2015. A statistical analysis was performed to compare the three different intervention arms: medical management, stent placement and surgical intervention. The results of our systematic review confirm the high mortality rate associated with AEF following left atrial ablation and the necessity to diagnose atrio-esophageal injury in a timely manner. The mortality rates of this complication are 96% with medical management alone, 100% with stent placement, and 33 % with surgical intervention. Atrio-esophageal injury and subsequent AEF is an infrequent but potentially fatal complication of atrial ablation. Early, prompt, and definitive surgical intervention is the treatment of choice.

End-tidal carbon dioxide (ETCO) monitoring is useful in many situations. However, ETCO monitoring is unreliable in patients with acute respiratory distress syndrome (ARDS) due to widespread lung inflammation. In our study, we attempt to establish the gradient between the arterial pressure of carbon dioxide (PaCO) and ETCO in patients with ARDS, which we defined as the PaETCO gradient. The main objective of the study was to establish a PaETCO gradient in each severity of ARDS. We analyzed 35 patients with ARDS and a total of 88 arterial blood gases were included. PaCO, PaO/FiO and ETCO were measured. Patients were stratified into mild, moderate and severe ARDS as classified by the Berlin ARDS criteria. PaCO and ETCO were compared at each severity stratification. The mean PaCO was 50.0, the mean ETCO was 26.6 and the gradient among all samples was 23.24 (±12.02). The mean gradient for each severity is as follows: mild: 19.3 (±9.9), moderate: 27.9 (±13.2) and severe: 23.9 (±7.8). The difference between the PaETCO gradient of the mild to moderate (p=0.001) and mild to severe groups (p=0.01) reached statistical significance. However, the difference between the moderate to severe groups did not reach statistical significance (p=0.48). We found the gradient between PaCO and ETCO in patients with ARDS is vast and tends to worsen with increasing severity of ARDS. This indicates that the gradient between the 2 may be used as an indicator of increasing severity of ARDS.

Clostridium septicum aortitis is a rare infection that has a strong association with occult colonic malignancy. There is also emerging evidence to support the combination of medical and surgical management over medical management alone. To the best of our knowledge, we report the 40th known case of C. septicum aortitis.