Artificial intelligence-enabled rapid and symptom-based medication recommendation system (COV-MED) for the COVID-19 patients

In a general COVID-19 population in Cox’s Bazar, Bangladesh, we developed a medication recommendation system based on clinical information from the electronic medical record (EMR). Our goal was also to enable deep learning (DL) strategies to quickly assist physicians and COVID-19 patients by recommending necessary medications. The general demographic data, clinical symptoms, basic clinical tests, and drug information of 8953 patients were used to create a dataset. The learning model in this COVID-MED model was created using Keras (an open-source artificial neural network library) to solve regression problems. In this study, a sequential model was adopted. In order to improve the prediction capability and achieve global minima quickly and smoothly, the COVID-MED model incorporates an adaptive optimizer dubbed Adam. The model calculated a mean absolute error of 0.0037, a mean squared error of 0.000035, and a root mean squared error of 0.0059. The model predicts the output medications, such as injections or other oral medications, with around 99% accuracy. These findings show that medication can be predicted using information from the EMR. Similar models allow for patient-specific decision support to help prevent medication errors in diseases other than COVID-19

Rickettsial illnesses as important causes of febrile illness in Chittagong, Bangladesh

We conducted a yearlong prospective study of febrile patients admitted to a tertiary referral hospital in Chittagong, Bangladesh, to assess the proportion of patients with rickettsial illnesses and identify the causative pathogens, strain genotypes, and associated seasonality patterns. We diagnosed scrub typhus in 16.8% (70/416) and murine typhus in 5.8% (24/416) of patients; 2 patients had infections attributable to undifferentiated Rickettsia spp. and 2 had DNA sequence-confirmed R. felis infection. Orientia tsutsugamushi genotypes included Karp, Gilliam, Kato, and TA763-like strains, with a prominence of Karp-like strains. Scrub typhus admissions peaked in a biphasic pattern before and after the rainy season, whereas murine typhus more frequently occurred before the rainy season. Death occurred in 4% (18/416) of cases; case-fatality rates were 4% each for scrub typhus (3/70) and murine typhus (1/28). Overall, 23.1% (96/416) of patients had evidence of treatable rickettsial illnesses, providing important evidence toward optimizing empirical treatment strategies

Cutaneous cysts with nail dystrophy in a young female: A classical association

Pachyonychia Congenita (PC) refers to a group of autosomal dominant disorders with variable clinical presentations. While nail dystrophy and plantar keratoderma are the most consistent features in all the variants, a myriad of other manifestations has been observed. This report highlights a case of young female presenting with multiple asymptomatic cutaneous cysts associated with plantar kearatoderma and nail dystrophy. Similar nail changes were evident in her son also. Such clinical presentation, in corroboration with histopathological evaluation of the cutaneous cyst prompted us to make a diagnosis of Pachyonychia Congenita type II

The bumpy face of che guevara: An interesting case

Placement of decorative tattoo on the skin may lead to various immunological, infective, and coincidental complications. Inoculation of human papillomavirus leading to development of verruca is an uncommon complication of tattoos. The present report highlights the development of verruca vulgaris, developing after 2 years of tattooing in a young male

Not Available

Not AvailableBackground Despite repeated outbreaks of poxvirus infections unique to the Indian subcontinent region and veterinary research work in this field, much less diagnostic awareness with resultant treatment protocols have been formulated in the human medical field. Aims With this objective in mind, a combined human medical and veterinary study was conducted on a recent outbreak of buffalopox infection in a village in northern India. Methods A team of doctors did the clinical examination and collected swab and serum samples from both cattle and humans, and these were subjected to viral isolation, cell culture, plaque reduction neutralization test, polymerase chain reaction, and partial genome sequencing. Results A clustered foci of 12 human patients aged 11–60 years, 12 buffaloes, and 10 cows were found to be affected with buffalopox infection with some atypical features. Conclusion Awareness, diagnosis, education, early intervention, and formulation of disaster guidelines are needed in view of the potential epidemiologic outbreak, if this happens in the future.Not Availabl

Infection prevention and control for COVID-19 response in the Rohingya refugee camps in Bangladesh: an intra-action review

Abstract Background Infection Prevention and Control (IPC) is critical in controlling the COVID-19 pandemic and is one of the pillars of the WHO COVID-19 Strategic Preparedness and Response Plan 2020. We conducted an Intra-Action Review (IAR) of IPC response efforts to the COVID-19 pandemic in Cox's Bazar, Bangladesh, to identify best practices, challenges, and recommendations for improvement of the current and future responses. Methods We conducted two meetings with 54 participants purposively selected from different organizations and agencies involved in the frontline implementation of IPC in Cox's Bazar district, Bangladesh. We used the IPC trigger questions from the WHO country COVID-19 IAR: trigger question database to guide the discussions. Meeting notes and transcripts were then analyzed manually using content analysis, and results were presented in text and quotes. Results Best practices included: assessments, a response plan, a working group, trainings, early case identification and isolation, hand hygiene in Health Facilities (HFs), monitoring and feedback, general masking in HFs, supportive supervision, design, infrastructure and environmental controls in Severe Acute Respiratory Infection Isolation and Treatment Centers (SARI ITCs) and HFs and waste management. Challenges included: frequent breakdown of incinerators, limited PPE supply, inconsistent adherence to IPC, lack of availability of uniforms for health workers, in particular cultural and gender appropriate uniforms and Personal Protective Equipment (PPE). Recommendations from the IAR were: (1) to promote the institutionalization of IPC, programs in HFs (2) establishment of IPC monitoring mechanisms in all HCFs, (3) strengthening IPC education and training in health care facilities, and (4) strengthen public health and social measures in communities. Conclusion Establishing IPC programmes that include monitoring and continuous training are critical in promoting consistent and adaptive IPC practices. Response to a pandemic crisis combined with concurrent emergencies, such as protracted displacement of populations with many diverse actors, can only be successful with highly coordinated planning, leadership, resource mobilization, and close supervision

Point-of-care lung ultrasound for the detection of pulmonary manifestations of malaria and sepsis: An observational study

Introduction Patients with severe malaria or sepsis are at risk of developing life-threatening acute respiratory distress syndrome (ARDS). The objective of this study was to evaluate point-of-care lung ultrasound as a novel tool to determine the prevalence and early signs of ARDS in a resource-limited setting among patients with severe malaria or sepsis. Materials and methods Serial point-of-care lung ultrasound studies were performed on four consecutive days in a planned sub study of an observational cohort of patients with malaria or sepsis in Bangladesh. We quantified aeration patterns across 12 lung regions. ARDS was defined according to the Kigali Modification of the Berlin Definition. Results Of 102 patients enrolled, 71 had sepsis and 31 had malaria. Normal lung ultrasound findings were observed in 44 patients on enrolment and associated with 7% case fatality. ARDS was detected in 10 patients on enrolment and associated with 90% case fatality. All patients with ARDS had sepsis, 4 had underlying pneumonia. Two patients developing ARDS during hospitalisation already had reduced aeration patterns on enrolment. The SpO2/FiO2 ratio combined with the number of regions with reduced aeration was a strong prognosticator for mortality in patients with sepsis (AUROC 91.5% (95% Confidence Interval: 84.6%-98.4%)). Conclusions This study demonstrates the potential usefulness of point-of-care lung ultrasound to detect lung abnormalities in patients with malaria or sepsis in a resource-constrained hospital setting. LUS was highly feasible and allowed to accurately identify patients at risk of death in a resource limited setting