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Pollution of industry-adjacent surface water bodies has become a major threat to the environment in Bangladesh. This study examined the health risks of concentrated heavy metals in Tongi, Shitalakkhya, and Dhaleshwari, which receive effluents from wastewater treatment plants. Samples were analyzed for heavy metals such as lead, cadmium, iron, magnesium, manganese, zinc, copper, chromium, and nickel. At all the locations, only Zn, Cu, and Ni did not exceed the Bangladesh standard for drinking water. The health risk was estimated using the hazard quotient (HQ) technique. There was a threat of health risks resulting from the exposure through ingestion, with Pb, Cd, Fe, Mg, and Cr being the main contributors. The orders of decreasing values of mean HQ were Mg > Pb > Fe > Cr > Cd, Mg > Fe > Pb > Cr > Cd, and Cr > Mg > Pb > Fe > Cd via oral intake for both adults and children at Tongi, Shitalakkhya, and Dhaleshwari, respectively. For dermal intake, the mean HQ for only chromium at Dhaleshwari exceeded the limit for both groups. The results emphasize the need for enhancement, proper operation, and maintenance of wastewater treatment facilities in order to meet the discharge quality standard.

Objectives: Chronic suppurative otitis media is a major cause of acquired hearing impairment, especially in children of developing countries. The study sought to explore the bacteriological profile and their antimicrobial susceptibility among patients of chronic suppurative otitis media from a tertiary care hospital in Bangladesh. Methods: A cross sectional microbiological study was conducted at the Department of Microbiology, Rajshahi Medical College, Bangladesh from January to December 2019. Aural swabs were collected aseptically from clinically suspected patients irrespective of age and gender attending the ear, nose and throat outpatient department of Rajshahi Medical College Hospital. Aerobic bacterial culture was done and isolates were identified through standard bacteriological identification scheme. Antimicrobial susceptibility testing of isolates was done by modified Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Results: Of 96 swabs, culture yielded a total of 73 bacterial isolates from 68(70.8%) culture-positive plates including 63 (65.6%) unimicrobial and 5 (5.2%) polymicrobial (mixed growth of a pair of bacteria) growths. Frequency distribution revealed, 40(55%) gram-negative and 33(45%) gram-positive bacteria with Staphylococcus aureus was the leading isolate (37%) followed by Pseudomonas aeruginosa (31.5%), Escherichia coli (13.7%), coagulase-negative Staphylococcus (8.2%), Klebsiella pneumoniae (5.5%) and Proteus spp. (4.1%). Gram-positive bacteria were found to be highly susceptible (100%) to Linezolid and Vancomycin followed by Imipenem (83 to 96.3%), while moderate to high resistance (44 to 67%) was observed against Ciprofloxacin, Ceftriaxone, Ceftazidime, Amoxicillin/Clavulanate and Clindamycin. For gram-negative bacteria, susceptibility ranged from 67 to 100% to Imipenem, 67 to 96% to Piperacillin/Tazobactam and 67 to 83% to Gentamicin, while moderate to high resistance (50 to 75%) was observed against Ciprofloxacin, Ceftriaxone, Ceftazidime and Amoxicillin/Clavulanate. Conclusion: Moderate to high level of multidrug-resistance especially to 3rd generation cephalosporins, Ciprofloxacin and Amoxicillin/Clavulanate is an alarming situation. It warns reinforcement of judicious antibiotic prescription and introduction of antibiotic stewardship program in the tertiary care hospitals. doi: https://doi.org/10.12669/pjms.37.3.3942 How to cite this:Khatun MR, Alam KMF, Naznin M, Salam MA. Microbiology of Chronic Suppurative Otitis Media: An update from a Tertiary Care Hospital in Bangladesh. Pak J Med Sci. 2021;37(3):821-826. doi: https://doi.org/10.12669/pjms.37.3.3942 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The direction-of-arrival (DoA) estimation of an acoustic source can be estimated with a uniform linear array using classical techniques such as generalized cross-correlation, beamforming, subspace techniques, etc. However, these methods require a search in the angular space and also have a higher angular error at the end-fire. In this paper, we propose the use of regression techniques to improve the results of DoA estimation at all angles including the end-fire. The proposed methodology employs curve-fitting on the received multi-channel microphone signals, which when applied in tandem with support vector regression (SVR) provides a better estimation of DoA as compared to the conventional techniques and other polynomial regression techniques. A multilevel regression technique is also proposed, which further improves the estimation accuracy at the end-fire. This multilevel regression technique employs the use of linear regression over the results obtained from SVR. The techniques employed here yielded an overall 63% improvement over the classical generalized cross-correlation technique.

Aims: To reinforce nurses’ initial physical health management knowledge on Darwen and Calder wards at Pendleview unit (LSCFT). This quality improvement project attempted to bridge the gap (of physical health knowledge) amongst nursing staff by providing a short teaching course of 3 topics to mental health nurses on Darwen and Calder ward at Pendleview mental health unit, Royal Blackburn Hospital. Methods: The quality improvement project was conducted using the PDSA (plan, do, study, act) cycle methodology. The sample included 20 mental health nurses across Darwen and Calder wards in Pendleview unit. Three teaching sessions were delivered to nursing staff by doctors on both Darwen and Calder wards (6 in total) covering blood sugar monitoring, EWS and escalation and pain management. Quantitative and qualitative data was collected via pre- and post-teaching feedback forms, assessing nurses’ confidence and knowledge in managing physical health conditions. Confidence and knowledge were both scored on Likert scales numbered from 1–5. Results: 85% of nurses (17 of 20) stated they had not received training on the teaching topics before starting work Data across the three teaching sessions revealed the following; Blood sugar monitoring (n=8): Mean confidence (1 – not at all confident, 5 – confident) increased from 2.75 95% CI [1.85, 3.65] to 4.75 95% CI [4.45, 5.05] out of 5. Mean knowledge (1 – very poor, 5 – extremely good) increased from 2.75 95% CI [2.292, 3.208] to 4.75 95% CI [4.45, 5.05] out of 5. EWS and escalation (n=6): Mean confidence increased from 3.5 95% CI [2.493, 4.507] to 4.3 95% CI [3.704, 4.896] out of 5. Mean knowledge increased from 3.5 95% CI [3.1, 3.9] to 4.5 95% CI [4.1, 4.9] out of 5. Pain management (n=6): Mean confidence increased from 4.33 95% CI [3.953, 4.707] to 4.83 95% CI [4.532, 5.128] out of 5. Mean knowledge increased from 3.5 95% CI [3.1, 3.9] to 4.67 95% CI [4.293, 5.047] out of 5. Conclusion: Physical health management teaching to mental health nursing staff has shown to increase nurses’ confidence and knowledge in physical health. Providing physical health management teaching trust wide can help to eliminate knowledge gaps among the nursing staff, irrespective of their prior knowledge. Flow charts, posters, and providing regular physical health teaching and training to nurses during induction and beyond can all aid to empower nursing staff. A further QI cycle could be explored, looking into new teaching content after determining any additional gaps in physical health knowledge of the nursing staff.

The incidence and prevalence rates of treated end-stage kidney disease (ESKD) patients are on the rise worldwide. Hemodialysis remains the main modality of providing renal replacement therapy for the ESKD patients, and the preferred vascular access is an arteriovenous fistula (AVF). The objective is to assess the patency rates and primary failures of the AVF. All patients who attended the Royal Hospital in Muscat, Oman, from January 2010 to December 2014 for AVF creation were included in this study. Data were extracted from the hospital's electronic medical record system where data are entered prospectively. During the period of study from 2010 to 2014, 465 primary fistulae were created in 427 patients. The mean age of the patient was 58 years. Only 6% needed general anesthesia, while the rest were done under regional or local anesthesia. Fifty-one percent of the patients were diabetic. Preemptive AVF was constructed in only 12% of patients. Most cases (47%) had left brachiocephalic (BC) fistulae. The left radiocephalic (RC) fistulae constituted 25.7% and the left brachiobasilic fistulae 9.9%. The remaining were constructed in the right upper limb. The total patency was achieved in 80% of fistulae and the failure rate was 20% at 6 months. Whereas, at 12 months, the total patency rate was 71% and the failure rate was 29%. Thus, we can conclude that more than 50% of patients, half of them being females, were diabetics. This resulted in more fistulae being constructed in the arm, namely left BC fistulae and left RC fistulae. Furthermore, it is important to note that only a very small percentage of patients had an established preemptive AVF. These factors may be responsible for a failure rate of 20% and 29% of the AVFs at 6 months and 12 months, respectively.

Fintech services such as mobile banking are gaining significant acceptance among the citizens in Bangladesh. Therefore, this study aims to explore the determinants that influence banking service users’ decisions to accept and use fintech services such as mobile banking in an emerging market, specifically in Bangladesh. A questionnaire was developed and distributed to individuals actively using banking services in Bangladesh. A total of 400 questionnaires were distributed to individuals who have active bank accounts. This study obtained a total of 315 valid responses that were deemed suitable for inclusion in the data analysis, with a response rate of 78.75%. Furthermore, a five-point Likert scale was utilized to evaluate the responses to the item-based questionnaire. To evaluate the hypotheses, a significance level of 5% was applied, and the data pertaining to the subject matter and purpose of this study were examined using the SPSS v.29. The results of the study display that the acceptance of mobile banking (fintech) services is pronouncedly shaped by perceived trust, privacy, and security but not by perceived risk. Importantly, perceived security (β value = 0.302) has the greatest impact on mobile banking acceptance among customers compared to other variables. This study contributes to the literature by investigating the propensity of using Fintech services within the context of mobile banking.

Purpose>The purpose of this paper is to show a comparative study of different direction-of-arrival (DOA) estimation techniques, namely, multiple signal classification (MUSIC) algorithm, delay-and-sum (DAS) beamforming, support vector regression (SVR), multivariate linear regression (MLR) and multivariate curvilinear regression (MCR).Design/methodology/approach>The relative delay between the microphone signals is the key attribute for the implementation of any of these techniques. The machine-learning models SVR, MLR and MCR have been trained using correlation coefficient as the feature set. However, MUSIC uses noise subspace of the covariance-matrix of the signals recorded with the microphone, whereas DAS uses the constructive and destructive interference of the microphone signals.Findings>Variations in root mean square angular error (RMSAE) values are plotted using different DOA estimation techniques at different signal-to-noise-ratio (SNR) values as 10, 14, 18, 22 and 26dB. The RMSAE curve for DAS seems to be smooth as compared to PR1, PR2 and RR but it shows a relatively higher RMSAE at higher SNR. As compared to (DAS, PR1, PR2 and RR), SVR has the lowest RMSAE such that the graph is more suppressed towards the bottom.Originality/value>DAS has a smooth curve but has higher RMSAE at higher SNR values. All the techniques show a higher RMSAE at the end-fire, i.e. angles near 90°, but comparatively, MUSIC has the lowest RMSAE near the end-fire, supporting the claim that MUSIC outperforms all other algorithms considered.

Academic leadership plays a critical role in fulfilling higher education institutions’ missions, fostering a competent workforce, and becoming a key driver in unlocking the potential to achieve sustainability goals. Within this context, the leadership effectiveness of academic deans is particularly significant. This study aims to identify the factors influencing the academic leadership effectiveness in public universities in Bangladesh. The study collected data from 318 faculty members of public universities. A combined methodology consisting of Partial Least Squares-Structural Equation Modeling (PLS-SEM), Fuzzy-Set Qualitative Comparative Analysis (fsQCA), and Necessary Condition Analysis (NCA) was utilized to analyze the collected data. The PLS-SEM results indicated that vision and goal setting (VG), management of the unit (MU), interpersonal relationships (IR), communication skills (CS), research/professional endeavors (PE), and quality of education in the unit (QEU) significantly influence deans’ leadership effectiveness. Further, five necessary and six sufficient conditions were discovered by fsQCA results, which also demonstrated the nonlinear and intricate interaction effects of the factors leading to leadership effectiveness (LE). Importantly, NCA findings revealed that all factors are essential for LE and have meaningful and substantial impact. Also, a minimum of 14.78% VG, 20.75% MU, 23.27% IR, 33.96% CS, 16.98% PE, and 10.06% QEU must be met to accomplish an 80% LE. Therefore, the findings provide useful insights for the higher education sector, university top management, potential academic leaders, and relevant stakeholders to improve leadership effectiveness at the tertiary education level. Moreover, this study is the first to explain the effectiveness of deans’ leadership through an expanded methodology that integrates both symmetric and asymmetric methods.

ObjectiveThe aim of this paper is to describe the stages undertaken to generate the items and conceptual framework of a new electronic personal assessment questionnaire for vascular conditions.DesignA mixed methods study: First a survey of vascular clinicians was completed to identify the most common conditions treated in vascular clinics and wards. Quantitative systematic reviews were done to identify validated patient-reported outcome measures (PROMs) for direct inclsuion in the new instrument. However, due to scarcity of validated PROMs, the items of the new instrument were mainly based on a large qualitative study of patients and systematic reviews of the qualitative evidence . This was followed by a quantitative clinicians’ consensus study and, finally, a qualitative face validity study with patients.ParticipantsVascular patients participated in the primary qualitative study and the face validity study. In the qualitative study, 55 patients were interviewed, and for the face validity, 19 patients gave feedback. Twelve clinicians completed the survey and 13 completed two cycles of the clinicians’ consensus study.ResultsThe items and scales in the electronic personal assessment questionnaire for vascular conditions (ePAQ-VAS) were generated based on the results of five systematic reviews evaluating existing PROMs for possible inclusion in ePAQ-VAS, five systematic reviews of qualitative evidence, a primary qualitative study involving 55 patients and clinicians’ input. One hundred and sixty-eight items were initially generated, of which 59 were eliminated by the expert panel due to repetition. The instrument was divided into one generic and three disease-specific sections (abdominal aortic aneurysm, carotid artery disease and lower limb vascular conditions). In each section, items were grouped together into putative scales. Fifty-five items were grouped across eight scales; the remaining items were kept as individual items, because of relevance to service users.ConclusionsThis multidimensional electronic questionnaire covers the most common vascular conditions. This is particularly important for patients presenting with mixed symptoms or multiple conditions. This tool captures symptomatology, health related quality of life (HRQoL) and other clinically relevant data, such as experience with services and comorbidities.

Background The outcome of an Entamoeba histolytica infection is variable and can result in either asymptomatic carriage, immediate or latent disease (diarrhea/dysentery/amebic liver abscess). An E. histolytica multilocus genotyping system based on tRNA gene-linked arrays has shown that genetic differences exist among parasites isolated from patients with different symptoms however, the tRNA gene-linked arrays cannot be located in the current assembly of the E. histolytica Reference genome (strain HM-1:IMSS) and are highly variable. Results To probe the population structure of E. histolytica and identify genetic markers associated with clinical outcome we identified in E. histolytica positive samples selected single nucleotide polymorphisms (SNPs) by multiplexed massive parallel sequencing. Profile SNPs were selected which, compared to the reference strain HM-1:IMSS sequence, changed an encoded amino acid at the SNP position, and were present in independent E. histolytica isolates from different geographical origins. The samples used in this study contained DNA isolated from either xenic strains of E. histolytica trophozoites established in culture or E. histolytica positive clinical specimens (stool and amebic liver abscess aspirates). A record of the SNPs present at 16 loci out of the original 21 candidate targets was obtained for 63 of the initial 84 samples (63% of asymptomatically colonized stool samples, 80% of diarrheal stool, 73% of xenic cultures and 84% of amebic liver aspirates). The sequences in all the 63 samples both passed sequence quality control metrics and also had the required greater than 8X sequence coverage for all 16 SNPs in order to confidently identify variants. Conclusions Our work is in agreement with previous findings of extensive diversity among E. histolytica isolates from the same geographic origin. In phylogenetic trees, only four of the 63 samples were able to group in two sets of two with greater than 50% confidence. Two SNPs in the cylicin-2 gene (EHI_080100/XM_001914351) were associated with disease (asymptomatic/diarrhea p = 0.0162 or dysentery/amebic liver abscess p = 0.0003). This study demonstrated that there are genetic differences between virulent and avirulent E. histolytica strains and that this approach has the potential to define genetic changes that influence infection outcomes.