A Clinico-Epidemiological Study on Poisoning among Commuters: Is There any Substance Abuse?

Background: Poisoning among commuters is becoming a major health hazards day by day in Bangladesh. Few studies were done in Bangladesh regarding this problem. To describe the clinico-epidemiological features of patients with suspected intentional poisoning during travel for robbery. Method:This was a prospective observational study, conducted in medicine department of Chittagong Medical College Hospital, Bangladesh during March 2010 to September 2010. 40 patients were selected. Out of whom, 15 who had GCS < 8 at presentation were selected for urine analysis by detection kits for a few substances in the urine. Detailed demographic data were collected from the informant in a structured case report form. Clinical examination of the patient was done at presentation and urine was collected in selected patients. Routine patient follow-ups were carried out and the outcome was recorded. Results: Victims being males of 31.23 ± 7.6 years of age, most of whom were married (80%), and businessmen (40%). Most of them were brought to hospital by their relatives (80%). Their financial loss by the incidence did not exceed 50,000 tk (i.e., 18937 Tk). They were mainly from middle class family, usually poisoned by beverage (55%), food (30%), and inhalation (5%). Most of them presented with unconsciousness (75%), having GCS 10 on average. Their pupils usually remained constricted bilaterally (75%) with intact light reflex in 35% of the cases. There was no papilledema, and cranial nerves were usually intact in those who could be examined (25%). Patients were usually depressed with absent planter reflex (70%) or flexor (30%). Within 2.5 days, most of them could walk without support and could be discharged. There was neither any case fatality reported or any long term disability recorded. Only 7.5% of the patients had substance examined by kit in their urine. Conclusion: We can come to the conclusion that money bearing people were victimized by the miscreant and they usually used a substance which has short onset of action and which can sedate people for a short time with depressive neurological findings

Queueing Theory Based Vehicular Traffic Management System Through Jackson Network Model and Optimization

Traffic congestion is increasing in over populated urban areas, our traditional traffic management system can no longer solve this problem. However, this problem can be solved by converting our road networks into queueing networks. This paper proposes, the use of an open Jackson Queueing Model which can be equated with our existing road network to calculate the waiting time of vehicles in the network, which can be further processed to put the network into an optimized state. In this model, the waiting time depends on both arrival rate and service rate. Our implementation designates a set of service rates from a range of possible service rates for each road within the network and these designated service rates are used to calculate waiting time. As these various combinations of service rates of different roads produce multiple waiting times, we select the combination set of service rates which has the lowest set of waiting times. This set of service rates is also compared with quadratic optimization problem of the same road network to evaluate implementation's accuracy

Hyponatremia in Severe Malaria: Evidence for an Appropriate Anti-diuretic Hormone Response to Hypovolemia

Although hyponatremia occurs in most patients with severe malaria, its pathogenesis, prognostic significance, and optimal management have not been established. Clinical and biochemical data were prospectively collected from 171 consecutive Bangladeshi adults with severe malaria. On admission, 57% of patients were hyponatremic. Plasma sodium and Glasgow Coma Score were inversely related (rs = −0.36, P < 0.0001). Plasma antidiuretic hormone concentrations were similar in hyponatremic and normonatremic patients (median, range: 6.1, 2.3–85.3 versus 32.7, 3.0–56.4 pmol/L; P = 0.19). Mortality was lower in hyponatremic than normonatremic patients (31.6% versus 51.4%; odds ratio [95% confidence interval]: 0.44 [0.23–0.82]; P = 0.01 by univariate analysis). Plasma sodium normalized with crystalloid rehydration from (median, range) 127 (123–140) mmol/L on admission to 136 (128–149) mmol/L at 24 hours (P = 0.01). Hyponatremia in adults with severe malaria is common and associated with preserved consciousness and decreased mortality. It likely reflects continued oral hypotonic fluid intake in the setting of hypovolemia and requires no therapy beyond rehydration

A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh

BACKGROUND: Fever is a common cause of hospital admission in Bangladesh but causative agents, other than malaria, are not routinely investigated. Enteric fever is thought to be common. METHODS: Adults and children admitted to Chittagong Medical College Hospital with a temperature of ≥38.0 °C were investigated using a blood smear for malaria, a blood culture, real-time PCR to detect Salmonella Typhi, S. Paratyphi A and other pathogens in blood and CSF and an NS1 antigen dengue ELISA. RESULTS: We enrolled 300 febrile patients with a negative malaria smear between January and June 2012: 156 children (aged ≤15 years) and 144 adults with a median (interquartile range) age of 13 (5-31) years and median (IQR) illness duration before admission of five (2-8) days. Clinical enteric fever was diagnosed in 52 patients (17.3 %), lower respiratory tract infection in 48 (16.0 %), non-specific febrile illness in 48 (16.0 %), a CNS infection in 37 patients (12.3 %), urinary sepsis in 23 patients (7.7 %), an upper respiratory tract infection in 21 patients (7.0 %), and diarrhea or dysentery in 21 patients (7.0 %). Malaria was still suspected in seven patients despite a negative microscopy test. S. Typhi was detected in blood by culture or PCR in 34 (11.3 %) of patients. Of note Rickettsia typhi and Orientia tsutsugamushi were detected by PCR in two and one patient respectively. Twenty-nine (9 %) patients died during their hospital admission (15/160 (9.4 %) of children and 14/144 (9.7 %) adults). Two of 52 (3.8 %) patients with enteric fever, 5/48 (10.4 %) patients with lower respiratory tract infections, and 12/37 (32.4 %) patients with CNS infection died. CONCLUSION: Enteric fever was confirmed in 11.3 % of patients admitted to this hospital in Bangladesh with non-malaria fever. Lower respiratory tract and CNS infections were also common. CNS infections in this location merit more detailed study due to the high mortality