Appendix is a small, closed tube that is about the size of 9 cm. It attaches to the beginning of our large intestine, where the small and large intestines meet. Appendicitis, an inflammation of appendix is mostly related with bacterial etiological agents. The present study is aimed to study bacterial etiological agent that infected the vermiform appendix. Sterile Swabs were used to collect samples from various abdominal sites in addition to the lump of infected appendix. The clinical samples were collected from 69 patients diagnosed as suspected appendicitis from various hospitals in Surat region. Bacterial etiological agents were isolated and identified by standard microbiological procedures. Aamong 69 samples collected, 62 isolates were identified with predominance of gram negative bacteria (n=39), however Staphylococcus aureus found as prime pathogen among all. Most of the gram negative isolates found more resistant to Ofloxacin while gram positives against Gentamycin. 47.8% of MDR and 51% of ESBLs producers were knocking outcomes of our study. Further the detection of biofilm formation capabilities of these isolates were carried out by Tube method and Higher degree of biofilm production observed by tube method in compare to microtiter plate method.

It is difficult task to predict the trend of precipitation meteorology and environmental sciences. The present study considered the monthly rainfall from 1960 to 2016 obtained from Bangladesh Meteorological Department (BMD).To examine Rainfall in Bangladesh and find a suitable model for forecasting is the main intention of this study with the help of SARIMA Approach.Original data plot shows that it is stationary and then tests Auto-Correlation Function (ACF), Partial Auto-Correlation Function (PACF). After taking first difference original data was transformed to stationary. Kwiatkowski-Phillips-Schmidt-Shin (KPSS) test with p-value of 0.1and Augmented Dickey- Fuller (ADF) test with p-value of 0.01 proved the stationarity of Rainfall data. On the basis ofleast Akaike Information Criterion (AIC)value we suggest SARIMA (0,0,0) (2,1,1)12 model is the best to predict monthly rainfall data. After diagnostic checking on SARIMA (0,0,0) (2,1,1)12 model, the Auto Regressive parameter was found to be statistically insignificant and SARIMA (0,0,0) (2,1,1)12 model that best fit and was used to forecasting 120 months (January2017- December 2022) seasonal Rainfall in Bangladesh.

Objective and Introduction: A wide variety of treatment options have become available for rheumatoid arthritis. Biosimilars are highly effective in treating rheumatoid arthritis but are rarely considered as first line therapy because of their high cost. This study evaluates cost effectiveness and affordability of various biosimilars available in market for rheumatoid arthritis.

Methodology: Three biosimilarsAdalimumab, Infliximab and Etanercept were compared in this study. Weighted average of proportion of patients achieving ACR (American College of Rheumatology)20, ACR 50 and ACR 70 were considered as measure of outcome from published clinical trials. The data related to the cost of the drugs has been collected from authenticated sources and cost effectiveness was calculated. Affordability is analysed comparing the price of drug and daily wage of an unskilled labour. The data related to daily wage of unskilled labour has been collected from the authenticated sources. 

Results: In this analysis we found that Etanercept was cost effective, it costs 2,42,000 for 78.6% patients achieving ACR 20, 50.5% patients achieving ACR 50 and 25.5% patients achieving ACR 70. The next least expensive option is Infliximab costing 2,97,000 for 76.1% patients achieving ACR 20, 57.63% patients achieving ACR 50 and 29% patients achieving ACR 70. Adalimumab is the expensive option costing 6,00,00 which is least effective when compared with the two options. It takes 691 days for an unskilled daily wager to afford etanercept to achieve above mentioned outcome. It takes 849 days wage of an unskilled daily wager to afford infliximab to achieve above mentioned outcome. It takes 1714 days wage of an unskilled daily wager to afford adalimumab to achieve above mentioned outcome. 

Conclusion: Our analysis indicates that Etanercept 25mg twice weekly is cost effective for achieving ACR20, ACR 50 and ACR 70 over a period of 22 weeks. Even though all these drugs are highly effective in the treatment of rheumatoid arthritis they are beyond the affordability of common man. The government of India should take effective measures to bring these drugs under DPCO regulation.