Study on the efficacy of ceftriaxone versus azithromycin for the treatment of uncomplicated enteric fever among the patients admitted in a tertiary level hospital

Background: Typhoid fever is a severe debilitating and potentially life threating illness. In Bangladesh, typhoid fever is a round the year problem which sometimes take epidemic proportions. The reasons behind such occurrences are unsafe water supply, defective sewage system and unhygienic food handling practice. This study aimed to compare the efficacy of ceftriaxone and azithromycin in the treatment of uncomplicated enteric fever.Methods: An observational study was conducted at the department of pharmacology in Dhaka medical college, Dhaka, Bangladesh. Data were collected from blood culture positive patients for Salmonella typhi and Salmonella paratyphi, who admitted in the Dhaka medical college and hospital, Dhaka during the period of July 2015 to June 2016. Data was collected by using a structured questioner, face to face interview, physical examination and investigation reports. Patients were hospitalized during the entire treatment period and at admission evaluation was made by history and physical examination in a structured format. Subjects ware asked regarding changes in symptoms and possible adverse effects of the study drugs. All patients were asked to return two weeks after completion of treatment for follow up. Blood culture of Salmonella typhi or Salmonella paratyphi were done in all cases. Total 91 patients were culture positive for either S. typhi or S. paratyphi which were finally studied.Results: During the study period out of 91 patients, 51 were receiving ceftriaxone and 40 were receiving azithromycin. Clinical cure was achieved in 46 patients (90%) of ceftriaxone group and in 31 patients (78%) in the azithromycin group. There were no significant differences of clinical cure between both treatment groups (p>0.05). Mean fever clearance time in ceftriaxone group was 3±1.4 days and was 4±1.6 days for azithromycin group. Difference in fever clearance time was statistically significant (p<0.05). No clinical relapses were detected in any study subject. No major side effects of both drugs occurred in any subject.Conclusions: These results indicated that both ceftriaxone and azithromycin were effective against enteric fever caused by sensitive organisms and multi drug resistant S. typhi and S. paratyphi. It is concluded that ceftriaxone is more effective and can be a convenient alternative for the treatment of enteric fever, especially in developing countries like us where medical resources are scarce

Thermoluminescence energy response of TLD-100 subjected to photon irradiation using Monte Carlo N-particle transport code version 5

Useful TL properties of TLD-100 that is an excellent candidate for using in TL dosimetry of ionizing radiation are demonstrated. This study is focused on response of TLD-100 subjected to photon irradiation. The thermoluminescence (TL) response of TLD-100 subject to various photon energy, ranging from 20 keV to 6 MeV, was investigated as energy absorbed in the TL material using Monte Carlo N-Particle transport code version 5 (MCNP5). The input parameters included in this study are experimental geometry specification, source information, material information, and tallies. Tally F6 is used in this simulation. The results from MCNP5 simulation show good agreement with previous experimental data. However, the data obtained from the simulation are greater than the experimental data especially in lower energy ranges

Efficacy of rifaximin among non-constipated irritable bowel syndrome patients with or without small intestinal bacterial overgrowth: a randomized, double-blind, placebo-controlled trial

Background: IBS is a functional gastrointestinal disorder marked by abdominal pain and changes in stool frequency or form. Recent studies indicate a link between IBS, especially the diarrhea-predominant subtype, and small intestinal bacterial overgrowth. This study aimed to evaluate symptom resolution among IBS patients with or without SIBO on rifaximin treatment as compared with placebo. Methods: A double-blind, placebo-controlled, randomized clinical trial took place at the Department of Gastroenterology, Dhaka Medical College and Hospital, from January to December 2019. In the study 104 non-constipated IBS patients were assessed for SIBO using gut aspirate culture. Those with SIBO (≥105 CFU/ml) and those without were randomly assigned (computer-generated) to receive either 1500 mg/day of rifaximin for 14 days or a placebo. Results: Among 104 non-constipated IBS patients, 39% had SIBO, with IBS-D patients more associated (83% vs. 60%). Rifaximin significantly improved symptoms in the SIBO group at 4 and 16 weeks (90% vs. 20%, p&lt;0.001; 66% vs. 15%, p&lt;0.001). In the non-SIBO group, significant improvement was observed at 4 weeks (38.7% vs. 18.8%, p&lt;0.001) but not at 16 weeks (25.8% vs. 18.8%, p=0.501). Rifaximin significantly improved abdominal pain, stool form, and frequency in the SIBO group compared to placebo. However, there was no significant improvement in the non-SIBO group. Conclusions: Rifaximin is superior to placebo in relieving symptoms of non-constipated IBS patients with SIBO

Thermoluminescence energy response of a germanium-doped optical fiber obtained using a Monte Carlo N-particle code simulation

This paper reports on the energy response of a Ge-doped optical fiber subjected to photon irradiation. The thermoluminescence (TL) responses of the Ge-doped optical fiber for various photon energies ranging from 20 keV to 6 MeV were investigated as energy absorbed in the TL material by using the Monte Carlo N Particle transport code version 5 (MCNP5). The results obtained are compared against results for the thermoluminescence dosimeter 100 (TLD-100). The input parameters included in this study were the geometry specification, the source information, the material information and tallies. Tally F6 is an important parameter in data card which was used in this simulation as a energy-dependant heating function instead of flux. Similar patterns of response were found for each dosimeter. The simulation shows that the optical fiber has a greater response than TLD 100 in the lower energy range, but the responses overlap in the higher energy ranges

Geographical Concentration of Rural Poverty in Bangladesh

This paper was presented at the dialogue on Mapping Poverty for Rural Bangladesh: Implications for Pro-poor Development. The dialogue was organised as part of CPD's ongoing agricultural policy research and advocacy activities with IRRI under the PETRRA project. The study reported geographical concentration of rural poverty in Bangladesh for 425 upazilas in 2000-01. The study measured and mapped incidence of poverty (using Headcount Index), intensity of poverty (using Poverty Gap Index) and severity of poverty (using Squared Poverty Gap Index). It has analyzed factors contributing to the spatial concentration of poverty. It is hoped that the findings of the study would be helpful in identifying target areas and priorities for agricultural R&D interventions and poverty reduction programmes.Poverty, Rural Poverty, Bangladesh

Nutrition: Basis for Healthy Children and Mothers in Bangladesh

Recent data from the World Health Organization showed that about 60% of all deaths, occurring among children aged less than five years (under-five children) in developing countries, could be attributed to malnutrition. It has been estimated that nearly 50.6 million under-five children are malnourished, and almost 90% of these children are from developing countries. Bangladesh is one of the countries with the highest rate of malnutrition. The recent baseline survey by the National Nutrition Programme (NNP) showed high rates of stunting, underweight, and wasting. However, data from the nutrition surveillance at the ICDDR, B hospital showed that the proportion of children with stunting, underweight, and wasting has actually reduced during 1984–2005. Inappropriate infant and young child-feeding practices (breastfeeding and complementary feeding) have been identified as a major cause of malnutrition. In Bangladesh, although the median duration of breastfeeding is about 30 months, the rate of exclusive breastfeeding until the first six months of life is low, and practice of appropriate complementary feeding is not satisfactory. Different surveys done by the Bangladesh Demographic and Health Survey, United Nations Children's Fund (UNICEF), and Bangladesh Breastfeeding Foundation (BBF) showed a rate of exclusive breastfeeding to be around 32-52%, which have actually remained same or declined over time. The NNP baseline survey using a strict definition of exclusive breastfeeding showed a rate of exclusive breastfeeding (12.8%) until six months of age. Another study from the Abhoynagar field site of ICDDR, B reported the prevalence of exclusive breastfeeding to be 15% only. Considerable efforts have been made to improve the rates of exclusive breastfeeding. Nationally, initiation of breastfeeding within one hour of birth, feeding colostrum, and exclusive breastfeeding have been promoted through the Baby-Friendly Hospital Initiative (BFHI) implemented and supported by BBF and UNICEF respectively. Since most (87-91%) deliveries take place in home, the BFHI has a limited impact on the breastfeeding practices. Results of a few studies done at ICDDR, B and elsewhere in developing countries showed that the breastfeeding peer-counselling method could substantially increase the rates of exclusive breastfeeding. Results of a study in urban Dhaka showed that the rate of exclusive breastfeeding was 70% among mothers who were counselled compared to only 6% who were not counselled. Results of another study in rural Bangladesh showed that peer-counselling given either individually or in a group improved the rate of exclusive breastfeeding from 89% to 81% compared to those mothers who received regular health messages only. This implies that scaling up peer-counselling methods and incorporation of breastfeeding counselling in the existing maternal and child heath programme is needed to achieve the Millennium Development Goal of improving child survival. The recent data showed that the prevalence of starting complementary food among infants aged 6-9 months had increased substantially with 76% in the current dataset. However, the adequacy, frequency, and energy density of the complementary food are in question. Remarkable advances have been made in the hospital management of severely-malnourished children. The protocolized management of severe protein-energy malnutrition at the Dhaka hospital of ICDDR, B has reduced the rate of hospital mortality by 50%. A recent study at ICDDR, B has also documented that home-based management of severe protein-energy malnutrition without follow-up was comparable with a hospital-based protocolized management. Although the community nutrition centres of the NNP have been providing food supplementation and performing growth monitoring of children with protein-energy malnutrition, the referral system and management of complicated severely-malnourished children are still not in place

Authorship Classification in a Resource Constraint Language Using Convolutional Neural Networks

Authorship classification is a method of automatically determining the appropriate author of an unknown linguistic text. Although research on authorship classification has significantly progressed in high-resource languages, it is at a primitive stage in the realm of resource-constraint languages like Bengali. This paper presents an authorship classification approach made of Convolution Neural Networks (CNN) comprising four modules: embedding model generation, feature representation, classifier training and classifier testing. For this purpose, this work develops a new embedding corpus (named WEC) and a Bengali authorship classification corpus (called BACC-18), which are more robust in terms of authors&#x2019; classes and unique words. Using three text embedding techniques (Word2Vec, GloVe and FastText) and combinations of different hyperparameters, 90 embedding models are created in this study. All the embedding models are assessed by intrinsic evaluators and those selected are the 9 best performing models out of 90 for the authorship classification. In total 36 classification models, including four classification models (CNN, LSTM, SVM, SGD) and three embedding techniques with 100, 200 and 250 embedding dimensions, are trained with optimized hyperparameters and tested on three benchmark datasets (BACC-18, BAAD16 and LD). Among the models, the optimized CNN with GloVe model achieved the highest classification accuracies of 93.45&#x0025;, 95.02&#x0025;, and 98.67&#x0025; for the datasets BACC-18, BAAD16, and LD, respectively

Experience in Managing Severe Malnutrition in a Government Tertiary Treatment Facility in Bangladesh

Children with severe acute malnutrition, defined as weight-for-height <70% of the reference median or bilateral pedal oedema or mid-arm circumference <110 mm having complications, were managed in the Nutrition Unit of the Chittagong Medical College Hospital (CMCH) following the guidelines of the World Health Organization, with support from Concern Worldwide Bangladesh and ICDDR,B. In total, 171 children aged less than five years (mean±SD age 23.5±15.3 months) were admitted during June 2005–May 2006. Of them, 66% were aged less than two years, and 84.2% belonged to households with a monthly income of less than US$40. The main reason for bringing children by their families to the hospital was associated major illnesses: bronchopneumonia (33$ 14.6 per child or approximately US$ 1 per child-day (excluding staff-cost). Food and medicines accounted for 42% and 58% of the total cost respectively. This study demonstrated the potential of addressing severe acute malnutrition (with complications) effectively with minimum incremental expenditure in Bangladesh. This public-private approach should be used for treating severe acute malnutrition in all healthcare facilities and the treatment protocol included in the medical and nursing curricula

Correlation of lipoprotein (a) level with severity of coronary lesion in coronary heart disease patients

Background: Cardiovascular diseases (CVDs) are the leading cause of death in developing nations, especially in low and middle-income countries (LMICs). Bangladesh has been undergoing an epidemiological transition from communicable to non-communicable diseases. This study aimed to investigate the association of risk factors with coronary heart disease (CHD) in patients from Bangladesh. Methods: This cross-sectional observational study was conducted in the department of cardiology, Chattogram Medical College and Hospital, Chattogram, Bangladesh from July 2018 to June 2019. A total of 100 patients were enrolled. Results: This cross-sectional study enrolled 100 CHD patients with a mean age of 53.21±10.29 years. The majority were obese (64, 64.0%), and hypertension was the most prevalent risk factor (77, 77.0%), followed by smoking (65, 65.0%) and dyslipidemia (58, 58.0%). Most patients had triple vessel disease (53, 53.0%), and significant CHD (81, 81.0%). Patients with severe CHD had higher levels of blood LDL-C, triglycerides, and Lp(a). Lp(a) levels, history of dyslipidemia, and LDL-C were independently associated with a Gensini score ≥20. These findings emphasize the independent association between Lp(a) and CHD severity, warranting greater attention to patients with elevated Lp(a) levels. Conclusions: This study suggested that Lp(a) is an independent risk factor for CHD in patients from Bangladesh. More attention should be paid to such patients with elevated Lp(a) level