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Water-in-diesel emulsion fuel has become a popular alternative fuel for diesel engines. The main limitation is related to its stability, whereby it relies heavily on surfactants to remain homogeneous, therefore causing production costs to rise. This paper highlights the application of real-time non-surfactant emulsion fuel supply system (RTES), a water/diesel emulsifying device without surfactants, to produce water-in-diesel emulsion fuel in a common rail direct injection diesel engine powered vehicle. In this study, RTES was installed near to the diesel fuel pump to ensure water-in-diesel emulsions were continuously fed to the engine. The test vehicle was set up on a roller dynamometer and operated following a modified West Virginia University (WVU) 5-Peak cycle. Fuel consumption and exhaust emissions were measured to determine the optimum water percentage of emulsion fuel and suitable timing for emulsion fuel to be introduced into the fuelling system based on the vehicle speed. The results revealed that the optimum water percentage of the emulsion fuel for the test vehicle is 10 wt%, as it was capable to reduce fuel consumption as well as nitrogen oxides and smoke emissions of a common rail direct injection diesel engine powered vehicle. [ABSTRACT FROM AUTHOR]

Background: Acute pancreatitis (AP) is a significant cause of acute abdominal pain, morbidity and hospitalization. Knowing the details of the clinico-pathological presentation and outcome of the disease may aid the better understanding of the disease. Objective: The study was designed to assess the clinico-pathological profile and to estimate immediate hospital outcome of acute pancreatitis patients admitted into a tertiary care hospital. Materials and methods: This hospital based cross-sectional type of observational study was conducted at Dhaka Medical College Hospital (DMCH), for one-year period (June 2018-May 2019). Total 106 established cases of acute pancreatitis were included in this study. Data was analyzed by the SPSS 22 Windows version and graph & chart were expressed by using SPSS 22 and MS Excel. The result was presented with tables and charts. Results: Among 106 patients, mean age of the patients was 42.5 ±11.3 SD (years), with male predominance (male: female-1.2:1). All of the patients complained abdominal pain (100%) while anorexia (48.1%), 43.4% had vomiting and 31.1% had fever. Regarding clinical signs, abdominal distension (45.3%), paralytic ileus (34.9%) and dehydration (43.4%) were found to be the major clinical signs. The common location of pain was in epigastric region (73.6%) with radiation to back in 20.8% patients. Pain was severe agonizing in nature in 76.4% cases. Of all, gall stone disease (17.0%) was the most prevalent cause. According to APACHE-II score, 74.5% patients had mild pancreatitis (APACHE-II <8) while according to Glasgow criteria, 66.0% had mild disease (Glasgow score <3). Mean APACHE-II score was 7.07±2.50 and Glasgow score was 2.90±2.33. Mean hospital stays were 8.9±3.6 days and NPO (nothing per oral) 4.9±1.9 days. Among the patients, 77.4% patients were alive and mortality rate was 22.6%. Conclusion: Although, a larger portion of the patients had no identifiable cause but gall stone was the most common etiology. Pain commonly located in epigastric region with radiation to back. Of all the cases, more than sixty percent of the patients had mild pancreatitis estimated by APACHE II score and Glasgow score. Mean hospital stays were about 9 days and nothing per oral was about 5 days. Overall mortality rate was 22.6%. [ABSTRACT FROM AUTHOR]

Background: Post-coronavirus disease (COVID-19) syndrome includes persistence of symptoms beyond viral clearance and fresh development of symptoms or exaggeration of chronic diseases within a month after initial clinical and virological cure of the disease with a viral etiology. We aimed to determine the incidence, association, and risk factors associated with development of the post-COVID-19 syndrome. Methods: We conducted a prospective cohort study at Dhaka Medical College Hospital between June 01, 2020 and August 10, 2020. All the enrolled patients were followed up for a month after clinical improvement, which was defined according the World Health Organization and Bangladesh guidelines as normal body temperature for successive 3 days, significant improvement in respiratory symptoms (respiratory rate <25/breath/minute with no dyspnea), and oxygen saturation >93% without assisted oxygen inhalation. Findings: Among the 400 recruited patients, 355 patients were analyzed. In total, 46% patients developed post-COVID-19 symptoms, with post-viral fatigue being the most prevalent symptom in 70% cases. The post-COVID-19 syndrome was associated with female gender (relative risk [RR]: 1.2, 95% confidence interval [CI]: 1.02–1.48, p = 0.03), those who required a prolonged time for clinical improvement (p<0.001), and those showing COVID-19 positivity after 14 days (RR: 1.09, 95% CI: 1.00–1.19, p<0.001) of initial positivity. Patients with severe COVID-19 at presentation developed post-COVID-19 syndrome (p = 0.02). Patients with fever (RR: 1.5, 95% CI: 1.05–2.27, p = 0.03), cough (RR: 1.36, 95% CI: 1.02–1.81, p = 0.04), respiratory distress (RR: 1.3, 95% CI: 1.4–1.56, p = 0.001), and lethargy (RR: 1.2, 95% CI: 1.06–1.35, p = 0.003) as the presenting features were associated with the development of the more susceptible to develop post COVID-19 syndrome than the others. Logistic regression analysis revealed female sex, respiratory distress, lethargy, and long duration of the disease as risk factors. Conclusion: Female sex, respiratory distress, lethargy, and long disease duration are critical risk factors for the development of post-COVID-19 syndrome. [ABSTRACT FROM AUTHOR]

Background: Snakebite is a neglected public health problem in many countries of the world. Being a tropical country Bangladesh is also facing this problem. In this case series we have tried to focus the illiteracy, prejudice and mismanagement happen in snake bite cases from primary to tertiary level and how effective management can save life of snake bite victim. Case presentation: Among the 29 snake bite cases admitted in a medicine ward of tertiary care hospital four were venomous bites-two male and two female. Our patients came from around Dhaka city. Though victim failed to bring the snake, by studying clinical features and syndromic approaches we suspected Kraits as the culprit in three cases and Cobra in one case. Time period between bite and attend to hospital ranged from 4 hr to 16.30 hours. All victims had inappropriate application of tourniquet to their limbs as a first aid management. Most of them first visit OZHA (traditional healer). Two of them developed respiratory failure. All cases were managed in ICU with polyvalent ASV. One developed anaphylaxis which was managed with adrenaline. All patients recovered completely. Conclusion: Arrival to hospital without delay, facilities for management with trained physicians and proper supply of ASV may reduce death from snake bite and reduce financial burden to the patient. Developing public awareness to remove prejudice about snakes and identifying venomous snake bite is also necessary. [ABSTRACT FROM AUTHOR]

• A framework computes workers trustworthiness based on trust and reputation factors. • It produces a degree of trustworthiness score for a fairer decision. • Sentiment analysis using Naïve Bayes to identify potential malicious workers. • Introduces the use of referrals to alleviate new workers' cold start problem. • Results show that our approach achieves greater accuracy in task allocation. Unlike crowdsourcing, Spatial Crowdsourcing (SC) requires workers to travel to a specific physical location to accomplish a task. Due to its open concept, the platform accepts any interested individual as workers or task requesters, including those who may be unreliable and untrustworthy. Deploying untrustworthy workers in spatial tasks can negatively impact the quality of the completed tasks, thus threatening the sustainability of the SC platform. Recent research has been carried out to evaluate workers' trustworthiness based on the Trust and Reputation (TR) system. Current TR system approaches for evaluating workers' trustworthiness are mostly relying on a single trust or reputation factor, and the decisions are mainly binary. This binary representation of trustworthiness is considerably rigid and may cause severe repercussions like, an untrustworthy worker who could be the victim of partial ratings may end up not getting any kind of spatial tasks from the system, or a trustworthy worker who may have malicious intention may be allocated a spatial task. To address these limitations, we propose a novel framework that allocates every spatial task according to a workers' degree of perceived trustworthiness computed based on multi-criteria trust and reputation factors using a Mamdani fuzzy inference system. Our work considers historical ratings to calculate reputation value, applies sentiment analysis to infer trust value, implements Mamdani fuzzy inference to determine trustworthiness degree, and introduces the concept of referral to mitigate worker cold-start problems in spatial crowdsourcing. Our experimental findings on the Yelp real-world datasets demonstrate the reliability of the proposed framework to allocate every spatial task of various types to the most trustworthy workers from huge crowds of available workers. When evaluated against other baseline approaches, our approach achieves greater accuracy in allocating the right tasks to the most trustworthy workers. [ABSTRACT FROM AUTHOR]

Introduction Chikungunya is an arthropod-borne virus endemic to Africa, Southeast Asia and India that causes acute febrile polyarthralgia and arthritis. In this short case series, we discuss six Bangladeshi patients with chikungunya fever. Though Bangladesh is in endemic zone, it is not common here, hence it demands attention for proper diagnosis and management. Case presentation The six cases of chikungunya we report occurred in native Bangladeshi women with ages ranging from 20 to 50 years and all having a middle class family background. Three women had severe incapacitating arthralgia as well as a maculo-papular rash and a high fever. The other three had a high grade fever and arthralgia only, but no rash. They were tested for chikungunya immunoglobulin M antibody and found to be positive in all cases. They were treated symptomatically with non-steroidal anti-inflammatory drugs and found responsive in most cases. Conclusion From this case series, it is evident that chikungunya is not that uncommon in Bangladesh. But the concomitant presence of other arthropod-borne infections with similar courses of illness makes most physicians less aware of this infection. An awareness and clinical knowledge are necessary to diagnose chikungunya infection properly. [ABSTRACT FROM AUTHOR]

Polycystic Ovary Syndrome (PCOS) is a condition that involves various metabolic dysfunctions such as insulin resistance (IR), hyperandrogenemia, obesity, dyslipidemia, and steroid hormone irregularities. Although the exact cause of PCOS is still unknown, it is known to cause several hormonal disturbances, including hyperandrogenemia, IR, and hyperinsulinemia. Insulin appears to disrupt all components of the hypothalamicpituitary-ovarian (HPO) axis, and ovarian tissue insulin resistance results in impaired metabolic signaling. This causes hyperandrogenemia, which is one of the primary causes of the symptoms of PCOS. Androgens may also lead to IR by modifying muscle tissue composition and functionality and increasing levels of free fatty acids, perpetuating the IR-hyperinsulinemia-hyperandrogenemia cycle. Obesity exacerbates hormonal imbalances, and in combination with dyslipidemia, amplifies cardiovascular and cerebrovascular risks. This review discusses the complex risk factors of PCOS, including genetic, epigenetic, and environmental factors. It also discusses the interconnected etiologies of metabolic dysfunctions of PCOS, its effective management, and metabolic consequences such as cardiovascular and cerebrovascular diseases. [ABSTRACT FROM AUTHOR]

Background: Psoriatic Arthritis (PsA) is a complex seronegative inflammatory arthritis associated with psoriasis, characterized by a wide range of clinical manifestations. This study aimed to explore the prevalence of PsA in arthritic patients along with associated demographic and clinical characteristics in a tertiary care setting in Bangladesh. Methods: This cross-sectional study was conducted at the Rheumatology Clinic of Dhaka Medical College Hospital over a period of 6 months from March 2018 to August 2018. A total of 600 arthritis patients underwent screening for PsA, with subsequent evaluations of confirmed cases based on the CASPAR criteria. Demographic and clinical characteristics were documented through face-to-face interviews and physical examination. For data collection, a pre-structured questionnaire was used. Disease activity was assessed using the DAPSA score. The study was conducted according to the 'Declaration of Helsinki'. The statistical analysis was done with SPSS v-21. Results: The prevalence of PsA in arthritis patients was 5%. Age distribution of PsA showed a majority in between 30-39 years age group with a mean of 36.33±11.86 (SD). Slight female predominance was reported with a percentage of 53.3%.Almost three-fourths of study patients presented with a current diagnosis of psoriasis while the rest had a personal history or family history. A higher incidence (67.7%) of plaque psoriasis was observed followed by sebopsoriasis (20%) and for the rest of the patients, the type of psoriasis was unknown. The disease mostly involved multiple joints (90%), with ankle and metacarpal joints being the most commonly affected at 43.3% and 33.3%, respectively. Disease activity was high in the majority of the patients according to the DAPSA score, representing 53.34% of the patients, with the remainder exhibiting moderate to low disease activity. Conclusion: The study revealed a significant incidence of PsA among the arthritic population which indicates a pressing need for further extensive research on PsA across diverse populations. [ABSTRACT FROM AUTHOR]

Background: In Bangladesh, preventive chemotherapy targeting soil-transmitted helminth (STH) infections in school-age children has been implemented since 2008. To evaluate the success of this strategy, surveys were conducted between 2017 and 2020 in 10 out of 64 districts. We estimate the geographic distribution of STH infections by species at high spatial resolution, identify risk factors, and estimate treatment needs at different population subgroups. Methodology: Bayesian geostatistical models were fitted to prevalence data of each STH species. Climatic, environmental, and socioeconomic predictors were extracted from satellite images, open-access, model-based databases, and demographic household surveys, and used to predict the prevalence of infection over a gridded surface at 1 x 1 km spatial resolution across the country, via Bayesian kriging. These estimates were combined with gridded population data to estimate the number of required treatments for different risk groups. Principal findings: The population-adjusted prevalence of Ascaris lumbricoides, Trichuris trichiura, and hookworm across all ages is estimated at 9.9% (95% Bayesian credible interval: 8.0-13.0%), 4.3% (3.0-7.3%), and 0.6% (0.4-0.9%), respectively. There were 24 out of 64 districts with an estimated population-adjusted STH infection prevalence above 20%. The proportion of households with improved sanitation showed a statistically important, protective association for both, A. lumbricoides and T. trichiura prevalence. Precipitation in the driest month of the year was negatively associated with A. lumbricoides prevalence. High organic carbon concentration in the soil's fine earth fraction was related to a high hookworm prevalence. Furthermore, we estimated that 30.5 (27.2; 36.0) million dosages of anthelmintic treatments for school-age children were required per year in Bangladesh. Conclusions/Significance: For each of the STH species, the prevalence was reduced by at least 80% since treatment was scaled up more than a decade ago. The current number of deworming dosages could be reduced by up to 61% if the treatment strategy was adapted to the local prevalence. Author summary: Bangladesh was in 2003 one of the world's countries that was most the affected by soil-transmitted helminthiasis, an infection of parasitic intestinal worms, with prevalence estimates as high as 55%. Following recommendations put forth by the World Health Organization (WHO), Bangladesh initiated a national deworming program based on school mass drug administration at six-month intervals, which started in 2008. Data collected between 2017 and 2020 showed that this program has lead to a striking decrease in prevalence, which was now between 10.5% and 1% depending on the species. Entering a close to elimination setting, the disease's control strategy can be refined according to local endemicity to reduce overtreatment. To inform such a shift, we predict the prevalence across Bangladesh at high spatial resolution and highlight zones of different endemicity. We also show the potential reduction of overtreatment and financial resources that could be achieved by treating according to WHO recommendations at the predicted endemicity levels. [ABSTRACT FROM AUTHOR]

Keywords: Asia; epidemiology; gout; Pacific; registry EN Asia epidemiology gout Pacific registry 1432 1434 3 08/03/23 20230801 NES 230801 Gout is the most prevalent inflammatory arthropathy in adults. Variables collected can be categorized into the following domains: demographics, comorbid conditions, gout history, gout treatments, serum urate levels, and gout flare (if present) (Table S1). In this Registry, participants will be considered as having gout when they have at least 1 episode of acute arthritis (gout flare) and are diagnosed as having gout by reporting physicians. [Extracted from the article]

There is increasing evidence of the post-COVID-19 suffering and decreased quality of life in the COVID-19 patients. This study aimed to assess the quality of life and associated factors of COVID-19 patients at one month after discharge from the hospital. This was a cross-sectional study that was conducted at the post-covid clinic of Dhaka Medical College Hospital (DMCH) where RT–PCR-confirmed adult COVID-19 recovered patients were enrolled one month after discharge from the same hospital. They were consecutively selected from January 01 to May 30. A pretested semi-structured questionnaire was used for the data collection for clinical variables. The generic multi-attributable utility instrument EQ-5D-5L was used for assessing health-related quality of life (HRQoL). A total of 563 patients were enrolled in the study. The patients had a mean age with standard deviation (±SD) of 51.18 (±13.49) years and 55.95% were male. The mean (SD) EQ-5D-5L index score and EQ-VAS scores were 0.78 (±0.19) and 70.26 (±11.13), respectively. Overall, 45.77%, 50.99%, 52.79%, 55.14% and 62.16% had problems (slight to extreme) in the mobility, self-care, usual activities, pain/discomfort and anxiety/depression dimensions, respectively. Patients aged ≥60 years had significant problem in mobility (odds ratio [OR] 3.24, 95% confidence interval [CI]: 1.07–9.77). Female participants were 5.50 times (95% CI: 2.22–13.62) more likely to have problems in their usual activities. In comparison to urban area, living in a peri-urban setting was significantly associated with problems in mobility (OR 1.89, 95% CI: 1.13–3.20), pain/discomfort (OR 1.82, 95% CI: 1.04–3.12) and anxiety/depression (OR 2.16, 95% CI: 1.22–3.84). Comorbid patients were 1.75 times (95% CI: 1.07–2.85) more likely to report problems in the pain/discomfort dimension. Presence of symptom(s) was associated with problems in self-care (OR 3.27, 95%CI: 1.31–8.18), usual-activity (OR 3.08, 95%CI: 1.21–7.87), pain/discomfort dimensions (OR 2.75, 95%CI: 1.09–6.96) and anxiety/depression (OR 3.35, 95%CI: 1.35–8.30). Specific management strategies should be planned to address the factors associated with low health-related quality of life in post-acute care of COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: Neuromyelitis optica is a relapsing–remitting disease characterized by a recurrent attack of optic neuritis and transverse myelitis; sometimes associated with acute brainstem syndrome. Systemic lupus erythematosus is an autoimmune multisystem disorder in which ocular involvement such as acute ischemic optic neuropathy is a rare manifestation. However, neuromyelitis optica can be associated with systemic lupus erythematosus. Case presentation: A 24-year-old Bangladeshi woman was admitted to the hospital with complaints of sudden, progressive, painless vision loss in both eyes, and progressive weakness in both lower limbs for 48 hours. She also gave a history of arthralgia, a photosensitive skin rash, intermittent fever, oral ulcerations, and alopecia for the last 2 months. On examination, the fundus was suggestive of bilateral acute ischemic neuropathy, and examinations of the lower limb revealed spastic paraparesis with sensory abnormality. Laboratory investigations revealed the presence of positive anti-aquaporin 4 antibody, strongly positive antinuclear antibody, and anti-ds DNA with the longitudinally extensive lesion on magnetic resonance imaging of the spinal cord. She was treated with methylprednisolone, hydroxychloroquine, and mycophenolate, and was discharged with improvement of her paraparesis. However, her vision did not improve substantially. Conclusion: The importance of this report is to shed some light on the occurrence of two devastating complications that is, bilateral acute ischemic optic neuropathy in systemic lupus erythematosus complicated by neuromyelitis optica, as well as evidence of rare presentations for systemic lupus erythematosus and treatment modalities of ischemic optic neuropathy with systemic lupus erythematosus. [ABSTRACT FROM AUTHOR]

The death toll of the coronavirus disease 2019 (COVID-19) has been considerable. Several risk factors have been linked to mortality due to COVID-19 in hospitals. This study aimed to describe the clinical characteristics of patients who either died from COVID-19 at Dhaka Medical College Hospital in Bangladesh. In this retrospective study, we reviewed the hospital records of patients who died or recovered and tested positive for COVID-19 from May 3 to August 31, 2020.All patients who died during the study period were included in the analysis. A comparison group of patients who survived COVID-19 at the same hospital during the same period was systematically sampled.All available information was retrieved from the records, including demographic, clinical, and laboratory variables. Of the 3115 patients with confirmed COVID-19 during the study period, 282 died.The mean age of patients who died was higher than that of those who survived (56.7 vs 52.6 years).Approximately three-fourths of deceased patients were male. History of smoking (risk ratio 2.3; 95% confidence interval: 1.6–3.4), comorbidities (risk ratio: 1.5; 95% confidence interal:1.1–2.1), chronic kidney disease (risk ratio: 3.2; 95% confidence interval: 1.7–6.25), and ischemic heart disease (risk ratio:1.8; 95% confidence interval: 1.1–2.9) were higher among the deceased than among those who survived. Mean C-reactive protein and D-dimer levels [mean (interquartile range), 34 (21–56) vs. 24 (12–48); and D-dimer [1.43 (1–2.4) vs. 0.8 (0.44–1.55)] were higher among those who died than among those who recovered. Older age, male sex, rural residence, history of smoking, and chronic kidney disease were found to be important predictors of mortality. Early hospitalization should be considered for patients with COVID-19 who are older, male, and have chronic kidney disease. Rapid referral to tertiary care facilities is necessary for high-risk patients in rural settings. [ABSTRACT FROM AUTHOR]

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may cause severe life-threatening diseases called acute respiratory distress syndrome (ARDS) owing to cytokine storms. The mortality rate of COVID-19-related ARDS is as high as 40% to 50%. However, effective treatment for the extensive release of acute inflammatory mediators induced by hyperactive and inappropriate immune responses is very limited. Many anti-inflammatory drugs with variable efficacies have been investigated. Colchicine inhibits interleukin 1 beta (IL-1β) and its subsequent inflammatory cascade by primarily blocking pyrin and nucleotide-binding domain leucine-rich repeat and pyrin domain containing receptor 3 (NLRP3) activation. Therefore, this cheap, widely available, oral drug might provide an added benefit in combating the cytokine storm in COVID-19. Here, we sought to determine whether adding colchicine to other standards of care could be beneficial for moderate COVID-19 pneumonia in terms of the requirement for advanced respiratory support and mortality. Methods and findings: This blinded placebo-controlled drug trial was conducted at the Dhaka Medical College Hospital, Dhaka, Bangladesh. A total of 300 patients with moderate COVID-19 based on a positive RT-PCR result were enrolled based on strict selection criteria from June 2020 to November 2020. Patients were randomly assigned to either treatment group in a 1:1 ratio. Patients were administered 1.2 mg of colchicine on day 1 followed by daily treatment with 0.6 mg of colchicine for 13 days or placebo along with the standard of care. The primary outcome was the time to clinical deterioration from randomization to two or more points on a seven-category ordinal scale within the 14 days post-randomization. Clinical outcomes were also recorded on day 28. The primary endpoint was met by 9 (6.2%) patients in the placebo group and 4 (2.7%) patients in the colchicine group (P = 0.171), which corresponds to a hazard ratio (95% CI) of 0.44 (0.13–1.43). Additional analysis of the outcomes on day 28 revealed significantly lower clinical deterioration (defined as a decrease by two or more points) in the colchicine group, with a hazard ratio [95%CI] of 0.29 [0.098–0.917], (P = 0.035). Despite a 56% reduction in the need for mechanical ventilation and death with colchicine treatment on day 14, the reduction was not statistically significant. On day 28, colchicine significantly reduced clinical deterioration measured as the need for mechanical ventilation and all-cause mortality. Conclusion: Colchicine was not found to have a significant beneficial effect on reducing mortality and the need for mechanical ventilation. However, a delayed beneficial effect was observed. Therefore, further studies should be conducted to evaluate the late benefits of colchicine. Clinical trial registration: Clinical trial registration no: ClinicalTrials.gov Identifier: NCT04527562 https://www.google.com/search?client=firefox-b-d&q=NCT04527562. [ABSTRACT FROM AUTHOR]

Background: Wearing masks or personal protective equipment (PPE) has become an integral part of the occupational life of physicians due to the coronavirus disease 2019 (COVID-19) pandemic. Most physicians have been developing various health hazards related to the use of different protective gears. This study aimed to determine the burden and spectrum of various health hazards associated with using masks or PPE and their associated risk factors. Methods: This cross-sectional survey was conducted in Dhaka Medical College from March 01–May 30, 2021, among physicians from different public hospitals in Dhaka, Bangladesh. We analyzed the responses of 506 physicians who completed case record forms through Google forms or hard copies. Findings: The mean (SD) age of the respondents was 35.4 [7.7], and 69.4% were men. Approximately 40% were using full PPE, and 55% were using N-95 masks. A total of 489 (96.6%) patients experienced at least one health hazard. The reported severe health hazards were syncope, severe dyspnea, severe chest pain, and anaphylaxis. Headache, dizziness, mood irritation, chest pain, excessive sweating, panic attack, and permanent facial disfigurement were the minor health hazards reported. Extended periods of work in the COVID-19-unit, reuse of masks, diabetes, obesity, and mental stress were risk factors for dyspnea. The risk factors for headaches were female sex, diabetes, and previous primary headaches. Furthermore, female sex and reusing masks for an extended period (> 6 h) were risk factors for facial disfigurement. The risk factors for excessive sweating were female sex and additional evening office practice for an extended period. Conclusions: Healthcare workers experienced several occupational hazards after using masks and PPE. Therefore, an appropriate policy is required to reduce such risks. [ABSTRACT FROM AUTHOR]

Background: The health care workers'(HCWs) are working 24/7 in managing devastating pandemic Corona virus disease19(COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) as front liner which leads them to be at highest risk for contacting infection. In Bangladesh, being a lower middle-income country and densely populated, the burden is much more on HCWs. Methods: We did a cross-sectional study with an aim to identify the prevalence, risk factors, and outcomes of SARS-CoV-2 infection among the HCWs in a COVID-19 dedicated tertiary care hospital. Statistical analysis was done in SPSS version-26. Multivariate regression analysis was done to evaluate risk factors responsible for COVID-19 infection and the severity of the COVID-19 disease. We expressed odds ratio with 95% CI, and considered the p-value of <0.05 as significant in the two-tailed test. Results: A total of 864 HCWs had participated with mean age of 34.16 ± 6.77 and 426 (49.31%) males. Among them 143 (16.55%) were tested RT-PCR positive for SARS-COV-2. Bronchial asthma/COPD and Hypertension were the most common co-morbidities with 23 (16.08%) for each. About 102 (71.33%) of the RT-PCR positive HCWs became symptomatic. Fever, cough and myalgia were the most common symptoms 84(82.35%), 67(65.69%) and 52(50.98%) respectively. Multivariate regression analysis revealed hypertension, gout, and working in the COVID-19 confirmed ward had a significant odds ratio for getting infected with SARS-CoV-2 [95% CI, p-value 1.91 (1.08 - 3.41), 0.027; 5.85 (1.33 - 25.74), 0.020; and 1.83 (1.10 - 3.03), 0.019]. Bronchial asthma/COPD and gout found to be risk factors for moderate to severe COVID-19 disease [95% CI, p-value 3.04 (1.01 - 9.21), 0.049 and 23.38 (3.42 - 159.72), 0.001]. Hospitalization rate was 12(85.7%), and 3(100%) and median hospital stays were 11 (5.5 - 15), and 20 (7 - 30) days for moderate and severe diseases respectively. Outcome was uneventful without any ICU admission and death. Conclusion: HCWs working in the COVID-19 confirmed ward are at increased risk of infection with SARS-COV-2. Some co-morbidities like hypertension and gout are important risk factors for contacting SARS-COV-2 infection. Bronchial asthma/COPD and gout favors disease severity. [ABSTRACT FROM AUTHOR]

Background: Gout is the most prevalent inflammatory arthritis in the Asia‐Pacific region and worldwide. This clinical practice guideline (CPG) aims to provide recommendations based on systematically obtained evidence and values and preferences tailored to the unique needs of patients with gout and hyperuricemia in Asia, Australasia, and the Middle East. The target users of these guidelines are general practitioners and specialists, including rheumatologists, in these regions. Methods: Relevant clinical questions were formulated by the Steering Committee. Systematic reviews of evidence were done, and certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation methodology. A multi‐sectoral consensus panel formulated the final recommendations. Results: The Asia‐Pacific League of Associations for Rheumatology Task Force developed this CPG for treatment of gout with 3 overarching principles and 22 recommendation statements that covered the treatment of asymptomatic hyperuricemia (2 statements), treatment of acute gout (4 statements), prophylaxis against gout flare when initiating urate‐lowering therapy (3 statements), urate‐lowering therapy (3 statements), treatment of chronic tophaceous gout (2 statements), treatment of complicated gout and non‐responders (2 statements), treatment of gout with moderate to severe renal impairment (1 statement), and non‐pharmacologic interventions (5 statements). Conclusion: Recommendations for clinically relevant scenarios in the management of gout were formulated to guide physicians in administering individualized care. [ABSTRACT FROM AUTHOR]

Background: Neuropsychiatric systemic lupus erythematosus (NPSLE) is well known for its varying presentations and poor outcomes, but little is evident about its distribution and characteristics among the Bangladeshi population. This study aimed to assess the pattern and prevalence of neuropsychiatric symptoms in female systemic lupus erythematosus (SLE) patients of Bangladesh. A retrospective study was conducted at a tertiary care hospital in Dhaka, Bangladesh, between January and December 2018. One hundred female SLE patients were included in the study purposively. Data were collected on sociodemographic and clinical characteristics of diagnosed SLE cases visiting the SLE clinic and indoor medicine department. Neuropsychiatric (NP) syndromes were defined according to the widely accepted American College of Rheumatology (ACR) nomenclature and case definitions. Results: A total of 244 NP events were identified in fifty-five patients. Headache was the most frequent symptom (55%), followed by cognitive dysfunction (50%), anxiety (49%), psychosis (43%), seizure (23%), depression (17%), and cerebrovascular disease (ischemic type, 7%). The NP manifestations were more prevalent among urban residents (58.2%), younger patients (41.8%), and patients with graduate-level education (34.5%). Besides, young age at diagnosis (p = 0.038), Raynaud's phenomenon (p = 0.015), other organ involvement (p < 0.001), and time of NPSLE development (p < 0.001) were found to be significantly associated with the development of these manifestations. Conclusion: NP damage is prevalent among Bangladeshi female SLE patients (55%) with headache and cognitive dysfunction being the most common symptoms. Routine screening for neuropsychiatric symptoms among suspected SLE cases and further evaluation with a larger population are warranted. [ABSTRACT FROM AUTHOR]

Background: Globally, studies have shown conflicting results regarding the association of blood groups with SARS CoV-2 infection. Objective: To observe the association between ABO blood groups and the presentation and outcomes of confirmed COVID-19 cases. Design, setting, and participants: This was a prospective cohort study of patients with mild-to-moderately severe COVID-19 infections who presented in the COVID-19 unit of Dhaka Medical College Hospital and were enrolled between 01 June and 25 August, 2020. Patients were followed up for at least 30 days after disease onset. We grouped participants with A-positive and A-negative blood groups into group I and participants with other blood groups into group II. Results: The cohort included 438 patients; 52 patients were lost to follow-up, five died, and 381 completed the study. The prevalence of blood group A [144 (32.9%)] was significantly higher among COVID-19 patients than in the general population (p < 0.001). The presenting age [mean (SD)] of group I [42.1 (14.5)] was higher than that of group II [38.8 (12.4), p = 0.014]. Sex (p = 0.23) and co-morbidity (hypertension, p = 0.34; diabetes, p = 0.13) did not differ between the patients in groups I and II. No differences were observed regarding important presenting symptoms, including fever (p = 0.72), cough (p = 0.69), and respiratory distress (p = 0.09). There was no significant difference in the median duration of symptoms in the two group (12 days), and conversion to the next level of severity was observed in 26 (20.6%) and 36 patients (13.8%) in group I and II, respectively. However, persistent positivity of RT-PCR at 14 days of initial positivity was more frequent among the patients in group I [24 (19%)] than among those in group II [29 (11.1%)]. Conclusions: The prevalence of blood group A was higher among COVID-19 patients. Although ABO blood groups were not associated with the presentation or recovery period of COVID-19, patients with blood group A had delayed seroconversion. [ABSTRACT FROM AUTHOR]

Background: We report relationship of wealth indices with self-reported diabetes data in Bangladeshi people. As a secondary objective we examine whether educational achievement can be used as a proxy of wealth indices. Methods: We have analyzed data of a nationally representative STEPS survey (STEPwise Surveillance of NCD risk factors) done in 2010 in 8808 adults selected at their households using a multistage cluster sampling approach to describe association of socioeconomic status with diabetes mellitus. We created wealth indices using principal component analysis based on a 20-item household asset items; and then divided subjects in to quartiles. Results: Prevalence of documented diabetes was 3.9% but it was more than 11 times (9.3%) in the fourth quartile (richest) compared to the first quartile (0.8%). This may either mean that the detection rate is higher among the higher socioeconomic group or there are some intervening factors accompanied by the economic achievements that favors occurrence or detection of diabetes in Bangladeshi adults. Conclusion: Future studies need to identify the factor(s) that provides such a putative effect. Educational achievement also has shown similar trend. Therefore, education might be a proxy variable to determine socioeconomic status instead of a long list of household asset items. [ABSTRACT FROM AUTHOR]

Gaucher’s disease (GD) is a lysosomal storage disorder due to glucocerebrosidase deficiency; it’s one of the rare genetic diseases for which therapy is now available. Lysosomal storage of the substrate in cells of the reticuloendothelial system leads to multisystem manifestations, including involvement of the liver, spleen, bone marrow, lungs, and nervous system. Three different subtypes have been identified: Type 1, non-neuropathic form, adult onset; type 2, acute neuropathic form, infantile onset; type 3, neuropathic form, juvenile onset. The diagnosis is confirmed by presence of less than 15% activity of the enzyme Glucocerebrosidase in peripheral leucocyte with presence of Gaucher cells in macrophase monocyte system, is the pathological hallmark. Enzyme replacement therapy (ERT) is now available. We are reporting a case here which presented with cytopenia and massive splenomegaly. This case has been presented to focus on the importance of clinical examinations, differentiating from other diseases of similar manifestations, enzyme activity and bone marrow study for early diagnosis. [ABSTRACT FROM AUTHOR]

Gaucher's disease (GD) is a lysosomal storage disorder due to glucocerebrosidase deficiency; it's one of the rare genetic diseases for which therapy is now available. Lysosomal storage of the substrate in cells of the reticuloendothelial system leads to multisystem manifestations, including involvement of the liver, spleen, bone marrow, lungs, and nervous system. Three different subtypes have been identified: Type 1, non-neuropathic form, adult onset; type 2, acute neuropathic form, infantile onset; type 3, neuropathic form, juvenile onset. The diagnosis is confirmed by presence of less than 15% activity of the enzyme Glucocerebrosidase in peripheral leucocyte with presence of Gaucher cells in macrophase monocyte system, is the pathological hallmark. Enzyme replacement therapy (ERT) is now available. We are reporting a case here which presented with cytopenia and massive splenomegaly. This case has been presented to focus on the importance of clinical examinations, differentiating from other diseases of similar manifestations, enzyme activity and bone marrow study for early diagnosis. [ABSTRACT FROM AUTHOR]

Background: A large number of kala-azar cases from a particular village in Debigonj upazila of Panchaghar, a remote district of Bangladesh, led us to carry out the study of the situation. Materials & methods: This cross-sectional study was done among clinically screened people at the health camp in two days in Dararhat in Debigonj upazila of Panchaghar. Results: Around 700 people were screened at the health camp and 51 (7.2%) were suspected to have either Kala-azar or related disorders where 42 (82%) were rk-39 test positive. The disease was more prevalent among adult (59.6%) and children (23.8%) under the age of 10 years. However, there was no clear linear relationship between the prevalence of the disease and age group. Kala-azar occurred in both male and female, and its prevalence did not correlate significantly with income. A history of fever (73.8%) and splenomegaly (45.2%) was noted in most of the kala-azar cases. A significant number of PKDL (26.2%) cases were also found in that area. Conclusions: Since there are a significant proportion of PKDL cases, eradication will be very tough unless the health authority take adequate measure to identify and treat them properly. [ABSTRACT FROM AUTHOR]

There are a number of gastrointestinal symptoms and complications of COVID-19. Asymptomatic increase in pancreatic enzymes and rarely symptomatic pancreatitis are observed in this disease. This article describes a 37-year-old male suffering from mildly symptomatic COVID-19 infection, who received tablet favipiravir for his management. His condition was improving, when he developed acute pancreatitis, diagnosed clinically, biochemically and also with help of abdominal ultrasound. When he developed this, all typical symptoms of COVID-19 were improved. As a result, role of favipiravir in the development of this pancreatitis was suspected. [ABSTRACT FROM AUTHOR]

In present study, performance and emissions of a 100 kVA common rail turbocharged diesel engine electric generator installed with an emulsifier free emulsion fuel supply system, known as Real-Time Non-Surfactant Emulsion Fuel Supply System (RTES) was investigated experimentally. This system uses a novel mixing system design upgraded from previous RTES design, with an omission of ultrasonic agitator component. In this system, water was injected into an emulsification device where water and diesel fuel were mixed and supplied to the engine as an emulsion fuel. It was found that water-in-diesel emulsions produced from this system increased the engine's Brake Thermal Efficiency (BTE) to a maximum point of 42.7%, a marked increase of 28.6% from the base diesel. Furthermore, Brake Specific Fuel Consumption (BSFC) was reduced as water percentage increases. Additionally, Nitrogen Oxides (NOx) emissions and smoke opacity were also reduced. However, water-in-diesel emulsion emitted increased carbon monoxide (CO) in lower to middle loads before a reduction was observed in higher loads. Interestingly, unburned hydrocarbons (UHC) emission reduced substantially for water-in-diesel emulsions with water percentages between 14% and 22%. In short, emulsifier free emulsion fuel produced by RTES was able to improve thermal efficiency and reduce fuel consumption and harmful emissions. • Implementation of a novel in-line emulsifier was used to produce water-in-diesel fuel. • A turbocharged common rail diesel electric generator was used in the experiments. • Thermal efficiency was enhanced for all water-in-diesel concentrations. • Smoke opacity decreased substantially with increasing engine load. • NOx reduction was not as high as previously reported studies. [ABSTRACT FROM AUTHOR]

Acquired hemophilia is a rare but acquired bleeding diathesis caused by autoimmune depletion of Factor VIII or IX. Diagnosis of Acquired Hemophilia requires clinical acumen. The condition is often under diagnosed as because it is rare and patients usually don't have any unusual personal or family history of bleeding episodes. Acquired hemophilia has an equal sex distribution. So, clinicians should suspect acquired hemophilia in any patients with unexplained persistent and profound bleeding from uncommon soft tissues and mucosa and having prolonged activated partial thromboplastin time (APTT) without other causes. Here we will report a 50-year-old lady presenting with recurrent spontaneous bruises and joint pain and swelling for 2 years. On examination we found multiple bruises and ecchymosis of different sizes with varying colour changes from bluish to greenish over different parts of her body including face, right shoulder, right elbow joint and 2nd and 3rd PIP joints. Lab findings showed decreased Hemoglobin with prolonged APTT which didn't correct in mixing study. After exclusion of other possible pathological conditions and on the basis of lab criteria we diagnosed the case as Acquired Hemophilia. She was successfully treated with blood transfusion, recombinant activated factor VIII, Steroid and supportive treatments and was discharged with improving symptoms, stable hematocrit and resolving bruises. [ABSTRACT FROM AUTHOR]

This study proposes a community rainwater harvesting (RWH) system as an alternative water supply solution for Paikgacha, a water-scarce coastal urban area in Bangladesh. Although individual household-based RWH systems have been implemented in many areas in Bangladesh, to date, no study has been conducted designing a community RWH system and assessing its reliability and financial feasibility. This study employs historical observed and available climate model predicted future rainfall data into stormwater management model (SWMM) for rainfall-runoff simulation of the community RWH, and compares SWMM's performance with rational formula based estimation. We then calculate volumetric and time reliability of the proposed system and assess its financial viability. We observe good agreement in reliability curves generated by SWMM and rational formula-based model. Under the historical rainfall scenario, our proposed community RWH shows up to 99% reliability for 100 L per day household demand, given that proper community size and storage tank size are chosen. Predicted rainfall pattern of 2041–2070 period shows similar reliability-tank size relation to that of historical observed rainfall; however, predicted high precipitation intensity during 2021–2040 and 2071–2100 seem to assist the system in attaining higher reliability. Cost-benefit analysis indicates the financial viability of the proposed system. Finally, we develop a nomograph incorporating interactive factors of RWH, which would ease decision making by the policymakers regarding the implementation of community RWH. [Display omitted] • Designing and modeling a community rainwater harvesting (RWH) system. • Estimation of climate change impacts on reliability and financial feasibility. • Up to 99% reliability can be achieved for certain community water demand scenario. • Community RWH is financially viable in the study area. • A decision making nomograph is developed for implementing community RWH. [ABSTRACT FROM AUTHOR]