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Abstract Introduction Snakebite envenomation poses a significant health risk, particularly in low-resource settings where access to proper treatment is limited. Case presentation This study reports two cases of Russell's viper bites in rural Bangladesh, involving 48 and 35-year-old Bangladesh males, respectively, and highlights the difficulties in providing adequate medical care and in treating any complications that may arise. Both cases involved delayed access to healthcare, initial visit to traditional healers, and the development of severe complications such as coagulopathy, renal failure. After the intervention both cases survived which is scarce in low resource settings. Conclusion The cases underscore the importance of early recognition, appropriate management, and improved healthcare infrastructure to optimize survival outcomes in snakebite cases in resource-limited settings. These cases will contribute valuable insights to the field of snakebite management and provide guidance for improving survival rates and outcomes among snakebite victims in Bangladesh.

A case of post-vaccination myelitis following administration of chick embryo cell rabies vaccine in a 20 year-old young lady is described. The case presented with paraplegia five days after receiving the third dose (on 12th day) of the vaccine for rabies. Myelitis was confirmed by signal changes on magnetic resonance imaging (MRI). She improved considerably on steroids treatment. This is the first case of myelitis following rabies chick embryo cell vaccination in Bangladesh. Ibrahim Med. Coll. J. 2012; 6(2): 76-77

Abstract A reliable understanding of linkages between meteorological, hydrological and agricultural droughts (MD, HD, and AD respectively) is crucial to building resilience and planning for future climate changes. Despite Australia being prone to severe droughts, lagtimes of propagation (and recovery), from meteorological to hydrological and agricultural droughts across its large hydroclimatic regions, are poorly understood. Therefore, we investigate the characteristics of drought propagation and recovery time lags for droughts of four timescales and a combination of drought onset and cessation criteria in 407 unregulated catchments within six major precipitation zones across the country. We find that the propagation and recovery lags depend on climatic conditions, drought criteria and timescales. The median of catchment average propagation times from MD to HD across Australia varied from 0.8 to 1.7 months for 1‐month timescales, increasing to 2.2–5.0 months for 12‐month timescales. The corresponding recovery lagtimes were 1.3–3.7 and 1.7–7.0 months respectively. Similarly, the median of catchment average propagation times from MD to AD ranged from 0.8 to 1.9 months for 1‐month timescales, increasing to 0.6–5.0 months for 12‐month. The corresponding recovery lagtimes were 0.7–2.8 and 0.3–8.7 months respectively. For droughts of smaller timescales, propagation and recovery lags are linearly correlated with recovery lagtimes consistently greater than propagation times. However, as the timescale increases, these relationships weaken suggesting effects of other catchment attributes (e.g., groundwater contributions) on lag relationships.

Objectives: The objectives of the current study was to evaluate the disinfection efficacy of ozone, ultraviolet (UV) radiation, herbal and glutaraldehyde method for sterilization of elastomeric impression materials. Materials and Methods: Disinfection of elastomeric impression material was performed with each of the disinfection methods: ozone, UV radiation, herbal, and glutaraldehyde. Later microbiological analysis was performed and the colony-forming units were evaluated and compared. Results: The highest disinfection efficacy was found with glutaraldehyde, followed by ozone and UV radiation, and the least with neem herbal rinse. Intergroup comparison was highly significant. Conclusion: Dry gaseous ozone and UV radiation can be used effectively for the disinfection of impressions.

AbstractPesticide self-poisoning is one of the three most important global means of suicide, killing an estimated 110–168,000 people each year, mostly in poor rural Asian communities. Organophosphorus (OP) and carbamate anticholinesterase insecticides are responsible for about two-thirds of these deaths. Calcium channel blocking medicines (CCB) may reduce the effect of pesticides and prevent deaths. Two preclinical rodents’ studies and eight clinical studies utilising nimodipine and magnesium sulphate (MgSO4), respectively, showed mixed results. We have established a multi-centre randomised controlled trial (RCT) of patients with OP or carbamate self-poisoning admitted to at least six major hospitals in Bangladesh. The study aims to recruit maximum 3,243 patients over four years. One-third of the patients selected at random will receive standard treatment, while one-third will be treated with additional nimodipine and one-third with additional MgSO4. The additional treatments will be given for 48 h. We will check mortality (currently an estimated 11% die with standard treatment) and need for intensive care for mechanical ventilation across the three groups. This could lead to development of the first novel treatment for anticholinesterase poisoning in 50 years and its introduction into routine hospital practice worldwide.

Abstract Background Microscopic examination of Giemsa-stained blood films remains the reference standard for malaria parasite detection and quantification, but is undermined by difficulties in ensuring high-quality manual reading and inter-reader reliability. Automated parasite detection and quantification may address this issue. Methods A multi-centre, observational study was conducted during 2018 and 2019 at 11 sites to assess the performance of the EasyScan Go, a microscopy device employing machine-learning-based image analysis. Sensitivity, specificity, accuracy of species detection and parasite density estimation were assessed with expert microscopy as the reference. Intra- and inter-device reliability of the device was also evaluated by comparing results from repeat reads on the same and two different devices. This study has been reported in accordance with the Standards for Reporting Diagnostic accuracy studies (STARD) checklist. Results In total, 2250 Giemsa-stained blood films were prepared and read independently by expert microscopists and the EasyScan Go device. The diagnostic sensitivity of EasyScan Go was 91.1% (95% CI 88.9–92.7), and specificity 75.6% (95% CI 73.1–78.0). With good quality slides sensitivity was similar (89.1%, 95%CI 86.2–91.5), but specificity increased to 85.1% (95%CI 82.6–87.4). Sensitivity increased with parasitaemia rising from 57% at 200–200,000 parasite/µL. Species were identified accurately in 93% of Plasmodium falciparum samples (kappa = 0.76, 95% CI 0.69–0.83), and in 92% of Plasmodium vivax samples (kappa = 0.73, 95% CI 0.66–0.80). Parasite density estimates by the EasyScan Go were within ± 25% of the microscopic reference counts in 23% of slides. Conclusions The performance of the EasyScan Go in parasite detection and species identification accuracy fulfil WHO-TDR Research Malaria Microscopy competence level 2 criteria. In terms of parasite quantification and false positive rate, it meets the level 4 WHO-TDR Research Malaria Microscopy criteria. All performance parameters were significantly affected by slide quality. Further software improvement is required to improve sensitivity at low parasitaemia and parasite density estimations. Trial registration ClinicalTrials.gov number NCT03512678.

IntroductionUnderstanding the human immune response to Plasmodium falciparum gametocytes and its association with gametocytemia is essential for understanding the transmission of malaria as well as progressing transmission blocking vaccine candidates.MethodsIn a multi-national clinical efficacy trial of artemisinin therapies (13 sites of varying transmission over South-East Asia and Africa), we measured Immunoglobulin G (IgG) responses to recombinant P. falciparum gametocyte antigens expressed on the gametocyte plasma membrane and leading transmission blocking vaccine candidates Pfs230 (Pfs230c and Pfs230D1M) and Pfs48/45 at enrolment in 1,114 participants with clinical falciparum malaria. Mixed effects linear and logistic regression were used to determine the association between gametocyte measures (gametocytemia and gametocyte density) and antibody outcomes at enrolment.ResultsMicroscopy detectable gametocytemia was observed in 11% (127/1,114) of participants at enrolment, and an additional 9% (95/1,114) over the follow-up period (up to day 42) (total 20% of participants [222/1,114]). IgG levels in response to Pfs230c, Pfs48/45 and Pfs230D1M varied across study sites at enrolment (p < 0.001), as did IgG seroprevalence for anti-Pfs230c and D1M IgG (p < 0.001), but not for anti-Pfs48/45 IgG (p = 0.159). In adjusted analyses, microscopy detectable gametocytemia at enrolment was associated with an increase in the odds of IgG seropositivity to the three gametocyte antigens (Pfs230c OR [95% CI], p: 1.70 [1.10, 2.62], 0.017; Pfs48/45: 1.45 [0.85, 2.46], 0.174; Pfs230D1M: 1.70 [1.03, 2.80], 0.037), as was higher gametocyte density at enrolment (per two-fold change in gametocyte density Pfs230c OR [95% CI], p: 1.09 [1.02, 1.17], 0.008; Pfs48/45: 1.05 [0.98, 1.13], 0.185; Pfs230D1M: 1.07 [0.99, 1.14], 0.071).ConclusionPfs230 and Pfs48/45 antibodies are naturally immunogenic targets associated with patent gametocytemia and increasing gametocyte density across multiple malaria endemic settings, including regions with emerging artemisinin-resistant P. falciparum.

Personal and genre-based approaches are an approach to learning English as an EFL language, specifically in narrative text writing. So far, no research has conducted a comprehensive comparative analysis between these two approaches. The purpose of this study is to determine which of the personal approach and genre-based approaches is more suitable for practical application in teaching narrative writing in EFL classrooms. By using the qualitative design through post-tests in writing narratives, and then interviews. The participants were 11th graders at SMK YMJ CIPUTAT. The results show that the genrebased approach in writing narrative text is more effective and interesting and students prefer the genre-based approach, based on the analysis of student writing with a total score of 82, while the personal approach (experience) with a score of 76, but personal experience can provide an alternative writing method that is interesting to students. Therefore, the genre-based approach can be used as the main method in learning to write, while the personal approach can be used as a complementary method. [ABSTRACT FROM AUTHOR]

Abstract The inclusion of sand columns results in enhancing the bearing capacity of clayey soil, increase the rate of consolidation, presentation of liquefaction in loose sandy soils and provide lateral resistance against the horizontal movement. This research aims at investigating the effects of floating columns in clayey soil with silty deposits by developing small scale laboratory models. The effects of sand columns on soils of different shear strengths, slenderness ratio (L/D) of columns were investigated. Group effect was also investigated by varying spacing between the columns. Experimental results were compared with the numerical analysis results. A 15-noded triangular mesh was generated using a finite element tool PLAXIS 2D. Finite element analysis was performed using Mohr’s Coulomb’s criterion considering undrained analysis for soft clayey soil and drained analysis for sand columns. It was concluded that the sand columns can significantly increase the ultimate loading capacity of soft soils. Results show that critical length for floating column ranges from 4 to 5.5 times the diameter of the column, beyond which bulging occurs and loading capacity decreased. The effect of group was also investigated and observed that with high spacing between the sand columns, the group efficiency decreased. The axial capacity of sand columns decreases while increasing spacing between the columns.

Combination of alumina (Al2O3) and zirconia (ZrO2) as cutting tool have been established themselves as a dominant in ceramic category for dry machining. The mechanical properties of Al2O3-ZrO2 cutting tool were critically dependent on its density and hardness, which affected by the powder preparation and sintering processes. This paper present the effect of sintering temperature on density, hardness and tool wear of Al2O3-ZrO2 cutting tool. Specific composition of 80-90 wt% Al2O3 and 10-20 wt% ZrO2 powders were mixed and ball milled for 12 hours. These powders then were compacted in the form of RNGN120600 designated cutting tool by using manual hydraulic press before undergone secondary compaction by Cold Isostatic Press. The compacted powders then were sintered from 1200oC to 1400oC at constant 9 hours soaking time. For each sintered cutting tool, evaluation has been made based on the density and hardness. By using AISI 1045 as a workpiece material, the wear performance of the selected cutting tools were evaluated within 200-350 m/min cutting speeds, 0.1 mm/rev feed rate and 0.5 mm depth of cut. The results shows that the sintering temperature at 1400oC and 9 hours soaking time produced maximum relative density and hardness for 90 wt% Al2O3 and 10 wt% ZrO2 at 94.17% and 63.4 HRC respectively. Cutting tool contained with 80 wt% Al2O3 and 20 wt% ZrO2 contributed maximum relative density of 97% and hardness of 70.07 HRC. Maximum tool life recorded was 156s at 200 m/min cutting speed. Wear mechanisms of fabricated cutting tool dominated by the notch and flank wear at the early stage of machining and formation built up edge at the end of machining process.

Abstract Background In severe falciparum malaria metabolic acidosis and acute kidney injury (AKI) are independent predictors of a fatal outcome in all age groups. The relationship between plasma acids, urine acids and renal function was investigated in adult patients with acute falciparum malaria. Methods Plasma and urinary acids which previously showed increased concentrations in proportion to disease severity in patients with severe falciparum malaria were quantified. Patients with uncomplicated malaria, sepsis and healthy volunteers served as comparator groups. Multiple regression and multivariate analysis were used to assess the relationship between organic acid concentrations and clinical syndromes, in particular AKI. Results Patients with severe malaria (n = 90), uncomplicated malaria (n = 94), non-malaria sepsis (n = 19), and healthy volunteers (n = 61) were included. Univariate analysis showed that both plasma and creatinine-adjusted urine concentrations of p-hydroxyphenyllactic acid (pHPLA) were higher in severe malaria patients with AKI (p

For countries aiming for malaria elimination, travel of infected individuals between endemic areas undermines local interventions. Quantifying parasite importation has therefore become a priority for national control programs. We analyzed epidemiological surveillance data, travel surveys, parasite genetic data, and anonymized mobile phone data to measure the spatial spread of malaria parasites in southeast Bangladesh. We developed a genetic mixing index to estimate the likelihood of samples being local or imported from parasite genetic data and inferred the direction and intensity of parasite flow between locations using an epidemiological model integrating the travel survey and mobile phone calling data. Our approach indicates that, contrary to dogma, frequent mixing occurs in low transmission regions in the southwest, and elimination will require interventions in addition to reducing imported infections from forested regions. Unlike risk maps generated from clinical case counts alone, therefore, our approach distinguishes areas of frequent importation as well as high transmission.

Abstract Background Artemisinin-resistant Plasmodium falciparum malaria parasites are now present across much of mainland Southeast Asia, where ongoing surveys are measuring and mapping their spatial distribution. These efforts require substantial resources. Here we propose a generic ‘smart surveillance’ methodology to identify optimal candidate sites for future sampling and thus map the distribution of artemisinin resistance most efficiently. Methods The approach uses the ‘uncertainty’ map generated iteratively by a geostatistical model to determine optimal locations for subsequent sampling. Results The methodology is illustrated using recent data on the prevalence of the K13-propeller polymorphism (a genetic marker of artemisinin resistance) in the Greater Mekong Subregion. Conclusion This methodology, which has broader application to geostatistical mapping in general, could improve the quality and efficiency of drug resistance mapping and thereby guide practical operations to eliminate malaria in affected areas.

This paper considers a proposed algorithm for computation of the inversekinematics(IK) model of the human arm. This algorithm introduces a new IK methodsuitable for reaching tasks performed by autonomous and interactive virtual humans.The basic problem is to pose the character in such a way that arm hand reaches thetarget ( position and orientation ) in space. The algorithm is composed of two phases.The first phase is the limitation of real task which concerning the human armmovement and the second phase presents the analytical solution for inverse kinematicsproblem (IKP) by trigonometric relations and algebraic solution according tolimitation of joints. This algorithm is simulated by using MATLAB Ver. R2008a, andsatisfied results are obtained, that explains the ability of the proposed algorithm tosolve the inverse kinematics problem for real human arm.

Melioidosis is known to occur in Bangladesh, but there are few reports about the condition in the published international literature. We set out to review all known cases of melioidosis in the country to date, using both retrospective and prospective data. A web-based literature search was conducted to identify all published case reports, original articles and conference abstracts. Cases were also included from a prospective study conducted in 2017. Fifty-one cases were identified between 1961 and 2017. Cases have been reported from sixteen out of the 64 districts of Bangladesh. The median age of the patients at presentation was 45 years (IQR 37–52), with a significant male (77%) predominance. Many patients (14/39; 36%) were farmers and 83% had diabetes mellitus. A skin/soft tissue abscess was the most common primary clinical presentation (13/49; 27%), followed by septic arthritis (10/49; 20%), pneumonia, and a deep-seated abscess/organ abscess (7/49; 14%). The major challenges to the diagnosis and treatment of melioidosis in Bangladesh are the lack of resources and the lack of awareness of melioidosis. Capacity development programs are urgently required to define the burden of disease and to tackle the mortality rates.

The fundamentals of free electron laser (FEL) theory are now well–establishedand can provide a sophisticated description of experiments over a wide rangeof parameters. While new technology is being developed for systems workingfrom 1mm to 10nm wavelengths, the theory remains the same. In this work,the final consequences of Lorentzian energy distribution in FEL amplifier willbe found by solving of Integro-differential equation using symbolic toolboxservices in MATLAB software v. 6.5 and the relation between severalparameters will be delimited and plotted in order to extract and present thecomplex relations between the FEL parameters.

Early start of enteral feeding is an established treatment strategy in intubated patients in intensive care since it reduces invasive bacterial infections and length of hospital stay. There is equipoise whether early enteral feeding is also beneficial in non-intubated patients with cerebral malaria in resource poor settings. We hypothesized that the risk of aspiration pneumonia might outweigh the potential benefits of earlier recovery and prevention of hypoglycaemia.A randomized trial of early (day of admission) versus late (after 60 hours in adults or 36 hours in children) start of enteral feeding was undertaken in patients with cerebral malaria in Chittagong, Bangladesh from May 2008 to August 2009. The primary outcome measures were incidence of aspiration pneumonia, hypoglycaemia and coma recovery time. The trial was terminated after inclusion of 56 patients because of a high incidence of aspiration pneumonia in the early feeding group (9/27 (33%)), compared to the late feeding group (0/29 (0%)), p = 0.001). One patient in the late feeding group, and none in the early group, had hypoglycaemia during admission. There was no significant difference in overall mortality (9/27 (33%) vs 6/29 (21%), p = 0.370), but mortality was 5/9 (56%) in patients with aspiration pneumonia.In conclusion, early start of enteral feeding is detrimental in non-intubated patients with cerebral malaria in many resource-poor settings. Evidence gathered in resource rich settings is not necessarily transferable to resource-poor settings.Controlled-Trials.com ISRCTN57488577.

An outbreak characterized by vomiting and rapid progression to unconsciousness and death was reported in Sylhet Distrct in northeastern Bangladesh following destructive monsoon floods in November 2007.We identified cases presenting to local hospitals and described their clinical signs and symptoms. We interviewed patients and their families to collect illness histories and generate hypotheses about exposures associated with disease. An epidemiological study was conducted in two outbreak villages to investigate risk factors for developing illness. 76 patients were identified from 9 villages; 25% (19/76) died. Common presenting symptoms included vomiting, elevated liver enzymes, and altered mental status. In-depth interviews with 33 cases revealed that 31 (94%) had consumed ghagra shak, an uncultivated plant, in the hours before illness onset. Ghagra shak was consumed as a main meal by villagers due to inaccessibility of other foods following destructive monsoon flooding and rises in global food prices. Persons who ate this plant were 34.2 times more likely (95% CI 10.2 to 115.8, p-value

BACKGROUND: Snake bite is a neglected public health problem in the world and one of the major causes of mortality and morbidity in many areas, particularly in the rural tropics. It also poses substantial economic burdens on the snake bite victims due to treatment related expenditure and loss of productivity. An accurate estimate of the risk of snake bite is largely unknown for most countries in the developing world, especially South-East Asia. METHODOLOGY/PRINCIPAL FINDINGS: We undertook a national epidemiological survey to determine the annual incidence density of snake bite among the rural Bangladeshi population. Information on frequency of snake bite and individuals' length of stay in selected households over the preceding twelve months was rigorously collected from the respondents through an interviewer administered questionnaire. Point estimates and confidence intervals of the incidence density of snake bite, weighted and adjusted for the multi-stage cluster sampling design, were obtained. Out of 18,857 study participants, over one year a total of 98 snake bites, including one death were reported in rural Bangladesh. The estimated incidence density of snake bite is 623.4/100,000 person years (95% C I 513.4-789.2/100,000 person years). Biting occurs mostly when individuals are at work. The majority of the victims (71%) receive snake bites to their lower extremities. Eighty-six percent of the victims received some form of management within two hours of snake bite, although only three percent of the victims went directly to either a medical doctor or a hospital. CONCLUSIONS/SIGNIFICANCE: Incidence density of snake bite in rural Bangladesh is substantially higher than previously estimated. This is likely due to better ascertainment of the incidence through a population based survey. Poor access to health services increases snake bite related morbidity and mortality; therefore, effective public health actions are warranted.

A survey was conducted to determine the presence of parasitic worm infection in cattle at four farms located in Kampung Surau Haji Daud, Kampung Kubang Jela, Kampung Gemuruh and Kampung Peradong, Kuala Terengganu. Thirty-three faecal samples and blood samples were obtained from each cattle involved in this survey. Faecal samples were subjected to sedimentation method, modified McMaster method and faecal culture to detect trematode eggs, nematode eggs, and to identify the third stage of larvae. Blood samples were subjected to Packed Cell Volume (PCV) method to determine if the cattle are anaemic normal or dehydrated. Result indicated that out of 33 cattle examined 17% of the cattle were positive for liver fluke, 67% were positive for stomach fluke and 42% were positive for nematode infection. PCV value indicated that all the cattle examined are not anaemic or dehydrated. The results obtained showed that trematode and nematode infections are common problem in all the four farms. The results were submitted to Department of Veterinary Services to plan further action and treatment. [ABSTRACT FROM AUTHOR]

Technological and methodological advances in multi-omics data generation and integration approaches help elucidate genetic features of complex biological traits and diseases such as prostate cancer. Due to its heterogeneity, the identification of key functional components involved in the regulation and progression of prostate cancer is a methodological challenge. In this study, we identified key regulatory interactions responsible for primary to metastasis transitions in prostate cancer using network inference approaches by integrating patient derived transcriptomic and miRomics data into gene/miRNA/transcription factor regulatory networks. One such network was derived for each of the clinical states of prostate cancer based on differentially expressed and significantly correlated gene, miRNA and TF pairs from the patient data. We identified key elements of each network using a network analysis approach and validated our results using patient survival analysis. We observed that HOXD10, BCL2 and PGR are the most important factors affected in primary prostate samples, whereas, in the metastatic state, STAT3, JUN and JUNB are playing a central role. Benefiting integrative networks our analysis suggests that some of these molecules were targeted by several overexpressed miRNAs which may have a major effect on the dysregulation of these molecules. For example, in the metastatic tumors five miRNAs (miR-671-5p, miR-665, miR-663, miR-512-3p and miR-371-5p) are mainly responsible for the dysregulation of STAT3 and hence can provide an opportunity for early detection of metastasis and development of alternative therapeutic approaches. Our findings deliver new details on key functional components in prostate cancer progression and provide opportunities for the development of alternative therapeutic approaches. [ABSTRACT FROM AUTHOR]

ABSTRACT In breaking the chain of the spread of Covid-19, one of the efforts that can be done is to undergo self- isolation (isoman). The purpose of implementing this isoman is to limit a person or area suspected of being infected from transmitting the virus to other people or to groups of people at risk. However, the various polemics that occur are often the community views negatively people who do isoman such as distancing themselves, lack of social sense and empathy. Therefore, this study aims to determine whether there is an effect of isoman implementation on community social relations that occur in the village area, namely Tawang Hamlet, Driyorejo Village, Nguntoronadi District, Magetan Regency and the City area in Jaya Maspion Permata Housing Block B4-63 Bangah Village, Gedangan District, Sidoarjo Regency. The method used in this research is descriptive qualitative to describe the reality in the field, through data obtained from interviews, observations and documentation. The results of the study indicate that there are differences in the availability of health facilities where the city area has complete facilities in terms of the use of hand sanitizers and oxygen cylinders, in contrast to Driyorejo Village where the availability of health care programs is still limited. Meanwhile, based on the results of respondents, social relations, both city and village residents, on average during self-isolation, residents work together and are enthusiastic to help fulfill logistics, such as basic needs, medicines, and others

Abstract Background Spread of malaria and antimalarial resistance through human movement present major threats to current goals to eliminate the disease. Bordering the Greater Mekong Subregion, southeast Bangladesh is a potentially important route of spread to India and beyond, but information on travel patterns in this area are lacking. Methods Using a standardised short survey tool, 2090 patients with malaria were interviewed at 57 study sites in 2015–2016 about their demographics and travel patterns in the preceding 2 months. Results Most travel was in the south of the study region between Cox’s Bazar district (coastal region) to forested areas in Bandarban (31% by days and 45% by nights), forming a source-sink route. Less than 1% of travel reported was between the north and south forested areas of the study area. Farmers (21%) and students (19%) were the top two occupations recorded, with 67 and 47% reporting travel to the forest respectively. Males aged 25–49 years accounted for 43% of cases visiting forests but only 24% of the study population. Children did not travel. Women, forest dwellers and farmers did not travel beyond union boundaries. Military personnel travelled the furthest especially to remote forested areas. Conclusions The approach demonstrated here provides a framework for identifying key traveller groups and their origins and destinations of travel in combination with knowledge of local epidemiology to inform malaria control and elimination efforts. Working with the NMEP, the findings were used to derive a set of policy recommendations to guide targeting of interventions for elimination.

Objective: The control room A and B employees are a high risk of benzene exposure, because they work close to the waste pit which is a source of benzene. This study is to analyze the magnitude of the health risk of benzene exposure to all employees. Methods: The data of this study were obtained from interviews and the results of environmental quality of PT X. Data were analyzed using Environmental Health Risk Analysis (EHRA) method which compared with RfC for non-carcinogenic effects and CSF for carcinogenic effects. Results: The results of individual calculations for the non-carcinogenic and carcinogenic effect of benzene are at a dangerous level in both real time and lifetime exposure. Conclusions: In the calculation of carcinogenic and non-carcinogenic risk exposure in real time, half the populations are at risk of being affected and in lifetime the entire populations are at risk of being exposed to these effects.

BACKGROUND:This study was conducted in Bangladeshi patients in an outpatient setting to support registration of Paromomycin Intramuscular Injection (PMIM) as a low-cost treatment option in Bangladesh. METHODOLOGY:This Phase IIIb, open-label, multi-center, single-arm trial assessed the efficacy and safety of PMIM administered at 11 mg/kg (paromomycin base) intramuscularly once daily for 21 consecutive days to children and adults with VL in a rural outpatient setting in Bangladesh. Patients ≥5 and ≤55 years were eligible if they had signs and symptoms of VL (intermittent fever, weight loss/decreased appetite, and enlarged spleen), positive rK39 test, and were living in VL-endemic areas. Compliance was the percentage of enrolled patients who received 21 daily injections over no more than 22 days. Efficacy was evaluated by initial clinical response, defined as resolution of fever and reduction of splenomegaly at end of treatment, and final clinical response, defined as the absence of new clinical signs and symptoms of VL 6 months after end of treatment. Safety was assessed by evaluation of adverse events. PRINCIPAL FINDINGS:A total of 120 subjects (49% pediatric) were enrolled. Treatment compliance was 98.3%. Initial clinical response in the Intent-to-Treat population was 98.3%, and final clinical response 6 months after end of treatment was 94.2%. Of the 119 subjects who received ≥1 dose of PMIM, 28.6% reported at least one adverse event. Injection site pain was the most commonly reported adverse event. Reversible renal impairment and/or hearing loss were reported in 2 subjects. CONCLUSIONS/SIGNIFICANCE:PMIM was an effective and safe treatment for VL in Bangladesh. The short treatment duration and lower cost of PMIM compared with other treatment options may make this drug a preferred treatment to be investigated as part of a combination therapy regimen. This study supports the registration of PMIM for use in government health facilities in Bangladesh. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT01328457.

BACKGROUND:Most adults dying from falciparum malaria will die within 48 hours of their hospitalisation. An essential component of early supportive care is the rapid identification of patients at greatest risk. In resource-poor settings, where most patients with falciparum malaria are managed, decisions regarding patient care must frequently be made using clinical evaluation alone. METHODS:We retrospectively analysed 4 studies of 1801 adults with severe falciparum malaria to determine whether the presence of simple clinical findings might assist patient triage. RESULTS:If present on admission, shock, oligo-anuria, hypo- or hyperglycaemia, an increased respiratory rate, a decreased Glasgow Coma Score and an absence of fever were independently predictive of death. The variables were used to construct a simple clinical algorithm. When applied to the 1801 patients, this algorithm's positive predictive value for survival to 48 hours was 99.4 (95% confidence interval (CI) 97.8-99.9) and for survival to discharge 96.9% (95% CI 94.3-98.5). In the 712 patients receiving artesunate, the algorithm's positive predictive value for survival to 48 hours was 100% (95% CI 97.3-100) and to discharge was 98.5% (95% CI 94.8-99.8). CONCLUSIONS:Simple clinical findings are closely linked to the pathophysiology of severe falciparum malaria in adults. A basic algorithm employing these indices can facilitate the triage of patients in settings where intensive care services are limited. Patients classified as low-risk by this algorithm can be safely managed initially on a general ward whilst awaiting senior clinical review and laboratory data.