Coastal water supply in Bangladesh

The coastal belt of Bangladesh extended over 76 Thanas is identified problem area where complex hydrogeological conditions and adverse water quality make water supply difficult as compared to other parts of the country. The entire belt is crisscrossed by rivers and their tributaries which are under active tidal influence. In spite of having large number of natural streams, ponds and a good ground water storage, the scarcity of potable water is acute. The river water, in most of the time in the year, is highly turbid and saline. The low saline pond water is used for many domestic purposes, but completely unsuitable for drinking. Unlike other areas of Bangladesh, ground water of acceptable quality is not available in most parts of coastal area at relatively shallow depths for easy withdrawal by conventional handpump tubewells. The use of easily available waters as source of domestic water supply requires extensive costly treatment which is not a practical proposition for scattered rural population nor affordable in the context of rural economic condition. Development of an alternative low cost water supply system required to improve the water supply situation in the coastal area of Bangladesh

Cost of water supply options for arsenic mitigation

Arsenic contamination of groundwater-based water supply has become a great concern in many countries of the world. Provision of alternative arsenic-safe water supply is a priority for protection of health but it requires mobilization of huge financial resources in highly affected countries. This paper presents a comparative analysis of costs of treatment of arsenic contaminated water and utilization of alternative water sources for safe water supply in arsenic affected areas. Because of the complexities in arsenic removal, the cost of treatment of arsenic contaminated water at the present level of technological advancement is high and beyond affordability of the low-income rural population. Some alternative water supply options can provide water at comparatively low cost but are not suitable at all locations. The costs of arsenic-safe water supply, convenience and limitations of most technological options for arsenic mitigation have been discussed

Methanol poisoning: 27 years experience at a tertiary care hospital

Methanol toxicity can result in serious morbidity and mortality without timely diagnosis and treatment. Many cases of methanol poisoning outbreaks have been noted in our population but no study has been performed to estimate methanol exposure and its outcomes and complications. A retrospective study was conducted to review all the cases of methanol poisoning admitted from January 1988 to December 2015 at the Aga Khan University Hospital. A total of 35 methanol poisoning cases were reported. All the patients were male, and the mean age was 36.2±8.6 years. The mean Glasgow Coma Scale score on presentation in the emergency was 10.4 ± 4.4. Blurring of vision was present in 17 (48%) patients while 10 (28%) had complete blindness. Mean arterial pH was 6.8±0.5 on arrival. Ethanol was given to 30(88%) patients and 12(32%) patients received bicarbonate for immediate treatment. A total of 15 (42.8%) patients underwent dialysis, out of which only 5 (33.3%) patients survived. Overall, 19 (54.3%) patients expired secondary to methanol ingestion

Parenchymal Thoracic Splenosis: History and Nuclear Imaging Without Invasive Procedures May Provide Diagnosis

Splenosis is a rare finding of ectopic splenic tissue found within the thoracic cavity, abdomen or peritoneal cavity. Most cases occur in the abdomen and the thoracic location is a comparatively rare finding. In thoracic splenosis the splenic tissue most often grows in the form of a nodule and the autotransplantation is usually caused by a previous operation and/or most commonly a penetrating or blunt trauma to the thoracoabdominal region, resulting in splenic rupture and in some cases left diaphragmatic tear. In majority of the cases the patients are asymptomatic and are incidentally diagnosed with left hemithorax pulmonary lesions found via chest radiography or thoracic computed tomography. We present a 45-year-old Caucasian male who was incidentally diagnosed with parenchymal thoracic splenosis secondary to a gunshot wound to the abdomen 13 years ago that resulted in distal pancreatectomy, splenectomy and gastrorrhaphy. In this case report we will briefly discuss the current updates in the literature regarding thoracic splenosis, and highlight the fact that the findings raise the suspicion of malignancy requiring numerous investigations yet early recognition of thoracic splenosis can prevent unnecessary tests and procedures. Preoperative diagnosis of splenosis should be made with the use of nuclear imaging studies such as the 99mTc heat-damaged erythrocyte study rather than computed tomography-guided biopsy or invasive surgery

Risk Assessment of Arsenic Mitigation Options in Bangladesh

The provision of alternative water sources is the principal arsenic mitigation strategy in Bangladesh, but can lead to risk substitution. A study of arsenic mitigation options was undertaken to assess water quality and sanitary condition and to estimate the burden of disease associated with each technology in disability-adjusted life years (DALYs). Dugwells and pond-sand filters showed heavy microbial contamination in both dry and monsoon seasons, and the estimated burden of disease was high. Rainwater was of good quality in the monsoon but deteriorated in the dry season. Deep tubewells showed microbial contamination in the monsoon but not in the dry season and was the only technology to approach the World Health Organization's reference level of risk of 10-6 DALYs. A few dugwells and one pond-sand filter showed arsenic in excess of 50 μg/L. The findings suggest that deep tubewells and rainwater harvesting provide safer water than dugwells and pond-sand filters and should be the preferred options

Measuring the patient safety culture at a tertiary care hospital in Pakistan using the hospital survey on patient safety culture (HSOPSC)

Background: Patient safety is a top priority for many healthcare organisations worldwide. However, most of the initiatives aimed at the measurement and improvement of patient safety culture have been undertaken in developed countries. The purpose of this study was to measure the patient safety culture at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC).Methods: The HSOPSC was used to measure the patient safety culture across 12 dimensions at Aga Khan University Hospital, Karachi. 2,959 individuals, who had been working at the hospital, were administered the HSOPSC in paper form between June and September 2019.Results: The response rate of the survey was 50%. In the past 12 months, 979 respondents (33.1%) had submitted at least one event report. Results showed that the personnel viewed the patient safety culture at their hospital favourably. Overall, respondents scored highest in the following dimensions: \u27feedback and communication on error\u27 (91%), \u27organisational learning and continuous improvement\u27 (85%), \u27teamwork within units\u27 (83%), \u27teamwork across units\u27 (76%). The dimensions with the lowest positive per cent scores included \u27staffing\u27 (40%) and \u27non-punitive response to error\u27 (41%). Only the reliability of the \u27handoffs and transitions\u27, \u27frequency of events reported\u27, \u27organisational learning\u27 and \u27teamwork within units\u27 was higher than Cronbach\u27s alpha of 0.7. Upon regression analysis of positive responses, physicians and nurses were found to have responded less favourably than the remaining professional groups for most dimensions.Conclusion: The measurement of safety culture is both feasible and informative in developing countries and could be broadly implemented to inform patient safety efforts. Current data suggest that it compares favourably with benchmarks from hospitals in the USA. Like the USA, high staff workload is a significant safety concern among staff. This study lays the foundation for further context-specific research on patient safety culture in developing countries

Risk Assessment of Arsenic Mitigation Options in Bangladesh

The provision of alternative water sources is the principal arsenic mitigation strategy in Bangladesh, but can lead to risk substitution. A study of arsenic mitigation options was undertaken to assess water quality and sanitary condition and to estimate the burden of disease associated with each technology in disability-adjusted life years (DALYs). Dugwells and pond-sand filters showed heavy microbial contamination in both dry and monsoon seasons, and the estimated burden of disease was high. Rain\uadwater was of good quality in the monsoon but deteriorated in the dry season. Deep tubewells showed microbial contamination in the monsoon but not in the dry season and was the only technology to approach the World Health Organization's reference level of risk of 10-6 DALYs. A few dugwells and one pond-sand filter showed arsenic in excess of 50 \u3bcg/L. The findings suggest that deep tubewells and rainwater harvesting provide safer water than dugwells and pond-sand filters and should be the preferred options

Arsenic mitigation: water quality of dug wells and tubewells

Arsenic concentration in very shallow and deep aquifers is comparatively lower than shallow aquifers in arsenic contaminated areas. As a result, dug wells and deep tubewells have emerged as two major water supply options for populations exposed to high levels of arsenic through drinking contaminated shallow tubewell water in Bangladesh and West Bengal (India). The concentrations of other impurities of health concern also vary with depth and other characteristics of the aquifer. Hence, shifting from one source to another may be the cause of exposure to health risk of a different nature. This paper presents an assessment of water quality of dug wells (DW) and deep tubewells (DTW) as compared to shallow tubewells (STW) for water supply. The results show that a shift from STW to DW reduces median arsenic ingestion from 151 μg/L (Mean 172μg/L) to 0.74 μg/L(mean 7.92μg/L), while DTW further reduces median arsenic ingestion to 0.41μg/L (mean 1.05μg/L). On the other hand, microbial contamination indicated by median value of Thermotolerant Coliform (TTC) count was found to be 48 cfu/100ml for DW water as compared to 0 cfu/100ml for both STW and DTW waters

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH