Square Pharmaceuticals Ltd.

Multiple drug resistance to Acinetobacter baumannii infection treatment is a great challenge for neuro‐intensivists due to poor drug penetration through the blood–brain barrier (BBB). Fortunately, the intraventricular administration of polymyxin‐B and tigecycline seems to be effective; there are few case reports demonstrating the effectiveness of such treatments. Here, we report the case of a 24‐year‐old male who presented with fever and neck rigidity after intracranial drainage following lung infection caused by MDR Acinetobacter baumannii. Due to the presence of turbid CSF, the administration of the intrathecal (ITH) route polymyxin‐B and tigecycline is not possible. In this situation, the neuro‐intensivist decided to start intraventricular tigecycline and polymyxin‐B administration along with IV tigecycline and polymyxin‐B via the intraventricular route, which was feasible because the patient had an external ventricular drain (EVD) due to obstructive hydrocephalus caused by the neurosurgeon after excision of the tumor.

This experiment investigated the impact of aloe vera gel and safe salts on the physical quality and physicochemical properties of minimally processed carrots during storage, aiming to determine the most effective edible coating postharvest treatment. The experiment employed a Completely Randomized Design (CRD) with three replications. Results indicated significant (p ≤ 0.01) effects of various treatments on the physical quality and physicochemical properties of carrots compared to untreated ones. Freshly harvested carrots were subjected to different treatments, including a control (T1), 30% aloe vera gel (T2), 1% NaCl (T3), and 1.5% NaHCO3 (T4), combinations thereof, such as 30% aloe vera gel with 1% NaCl (T5) or 1.5% NaHCO3 (T6), and 1% NaCl with 1.5% NaHCO3 (T7), and a combination of 30% aloe vera gel with 1% NaCl and 1.5% NaHCO3 (T8). Among the treatments, the combination of 30% aloe vera gel and 1% NaCl (T5) exhibited the most promising results after nine days of storage, with the lowest weight loss (1.19%), highest firmness (3.80 N), total soluble solids (TSS) content (8.40%), titratable acidity (0.477%), ascorbic acid content (9.02 mg/100 g FW), anthocyanin content (28.84 μg/g FW), phenol content (4.278 mg/100 g FW), and total sugar content (13.32%). This treatment effectively protected carrots from undesirable color, texture, and flavor changes during storage. The utilization of natural‐source‐based edible coatings containing health‐promoting additives presents a viable strategy to enhance both the internal and external qualities of minimally processed carrots. Overall, the edible coating comprising 30% aloe vera gel and 1% NaCl emerges as a promising approach for preserving the quality of minimally processed carrots.

Expanded dengue syndrome is a severe form of dengue fever that can cause acute liver failure and patients with this condition have a high mortality rate. This is because it can cause a cytokine storm, Unfortunately, standard treatments are often ineffective. Therapeutic plasma exchange is a procedure that removes cytokines and improves the patient's condition. Our study involved 15 patients with expanded dengue syndrome having acute liver failure, who were not responding to standard therapies. We treated them with plasmapheresis, and 11 of the patients showed significant improvement in liver function and survived. Unfortunately, the remaining four patients died owing to other complications. Early treatment is crucial for the best possible outcome.

Background Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation, leading to substantial morbidity and disability. Timely initiation of Disease-Modifying Anti-Rheumatic Drugs (DMARD) is imperative for effective management, yet delays in initiation persist. This research investigates the factors contributing to delays in DMARD initiation among RA patients, aiming to enhance our understanding of barriers and propose strategies for improvement. Objectives To determine the delay (lag time) between the onset of symptoms and the initiation of DMARDs in patients with RA and to assess the factors responsible for the delay. Methods This cross-sectional study was conducted in the outpatient department of rheumatology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh. A mixed-methods approach was employed, involving retrospective analysis of medical records, cross-sectional surveys, and interviews. For generating factors that may be responsible for the delay, group discussions were done. The group included seven members (three rheumatologists and four residents). A preliminary questionnaire was served to 10 patients to refine the questionnaire and add factors. A total of 187 patients aged ≥18 years who met 2010 ACR/EULAR criteria for RA were enrolled after having written informed consent. Patients who failed to reproduce medical records and were unable to give an adequate history were excluded from the study. Associations between the lag time and the factors affecting the lag time were analyzed by multiple linear regression analysis. Results A total of 154 patients were included. The average disease duration was 61.3±55.7 months. 22% of patients had deforming disease. The first physician visit occurred approximately 8.1 months after the onset of the symptoms, whereas the mean duration of the initial physician visit to the start of DMARD was around 20.5 months. The mean lag time between the onset of symptoms and the start of DMARD therapy was 28.6±36.1 months. Only 29.9% of our patients initially attended with a qualified medical graduate. Of them, only 11% attended to a rheumatologist. Whereas 38.3% attended to a general practitioner at the onset of their disease, followed by orthopedic surgeons (19.5%), physical medicine specialists (14.3%), internal medicine specialists (4.5%), nephrologists (3.2%), neurologists (3.9%), neurosurgeons (0.6%), and cardiologists (1.9%). The majority of the patients (70.1%) took initial remedies from non-qualified practitioners like medicine shopkeepers (27.3%), rural practitioners (16.2%), homeopathic practitioners (15.6%), kobiraj or ayurvedic practitioners (7.1%), unani (1.9%), and herbal medicine (1.3%) practitioners at the onset of their symptoms. A total of 64.3% of our study subjects believed that indigenous medicine was effective. The mean distance from the nearest rheumatology services for our patients was 48.7±59.7 kilometers, whereas the mean distance from the nearest healthcare facility was 4.4±3.8 kilometers. Only 29.2% of our study patients could start DMARD treatment within 3 months of disease onset. Most of our patients got methotrexate as their starting DMARD (89.6%). Referral to the right specialty, like rheumatologist or a trained internal medicine specialist, was not done by primary care physicians for the majority of our patients (59.7%). Primary care physicians started DMARD treatment for only 30% of RA patients. Several factors were found to be significant in the regression model, like the predominant pattern of initial joint involvement, distance from the residence to the nearest rheumatology service provider, inappropriate referral by a primary care physician, year of RA symptom onset, and lack of correct information on the availability of physicians with expertise in RA treatment. Conclusion Minimizing the delays in the diagnosis of RA and starting DMARD at an early stage will prevent complications related to the disease. Measures like increasing the number of rheumatologists, establishing a referral system, and creating awareness among patients, caregivers, and policymakers are required. REFERENCES NIL Acknowledgements NIL Disclosure of Interests None declared

To evaluate the effect of sawdust (SD) and rice straw (RS) on yield of different strains of Pleurotus cystidiosus (PCYS1-5), various yield attributes were measured in the present experiment. Among them, the best effect had been observed in the case of PCYS2. The highest mycelial running rate was observed in PCYS-2 + SD (0.84 cm). The highest average number of fruiting body/packet was observed in the treatment PCYS-2 +SD (61.00), followed by PCYS-1 +SD (58.00), PCYS-2 +RS (58.00) and the lowest in the treatment PCYS-3 +RS (47.00). The highest biological yield was observed in PCYS-2 + SD (255.6 g) and the lowest in PCYS-1 + RS (193.7 g). PCYS-2 + SD also showed the highest biological (255.6 g) and economic yield (188.3 g), the dry yield (25.02 g) and the highest biological efficiency of (85.20%). However, the highest cost benefit ratio was calculated in treatment PCYS-3 + RS (7.69) and the lowest cost benefit ratio 6.34 was calculated for PCYS-3 + SD and PCYS-4 + RS. Thus, saw dust stands out as the better substrate and the PCYS-2 as the best strain in the present experiment.

Background: Empagliflozin is a relatively newer glucose-lowering drug (GLD) with many extra-glycemic benefits. To date, no study has evaluated the efficacy and safety of empagliflozin in Bangladeshi patients with type 2 diabetes mellitus (T2DM). Objectives: To assess the efficacy and safety of empagliflozin as an add-on to ongoing GLDs in Bangladeshi adults with uncontrolled T2DM. Materials and Methods: This real-world, multicenter, open-label, prospective study was carried out at 21 sites throughout Bangladesh from 1 February 2022 to 31 July 2022. Patients with T2DM who met the criteria had Empagliflozin added to their existing GLD treatment, with necessary modifications to their ongoing medication regimen. The efficacy and safety data were collected 12 weeks after empagliflozin initiation. Results: Out of 1449 subjects initiating empagliflozin, 1340 subjects [age 50.3 ± 9.0 years, male 52.5%, overweight/obese 94.4%, insulin-treated 25.7%, baseline hemoglobin A1c (Hba1c) 9.9 ± 1.4%] completed the study. At 12 weeks, the reduction in HbA1c was 1.6% (95% CI 1.5-1.6, P < 0.001); 12.5% of the study subjects achieved HbA1c < 7%. There were also significant ( P < 0.001 in all instances) reductions in fasting plasma glucose (3.0 mmol/L), plasma glucose 2 hours after breakfast (4.8 mmoL/L), body weight (1.9 kg), body mass index (0.8 kg/m ² ), systolic blood pressure (BP) (10 mmHg), diastolic BP (7 mmHg), insulin dose (3 U), serum creatinine (0.06 mg/dL), total cholesterol (18 mg/dL), low-density lipoprotein cholesterol (13 mg/dL), high-density lipoprotein cholesterol (1 mg/dL), and triglyceride (42 mg/dL) and an increase in estimated glomerular filtration rate (4.2 mL/min/1.73 m ² ) from the baseline values. 6.62% experienced adverse events (lightheadedness 2.21%, genital tract infection 0.97%, urinary tract infection 1.24%, generalized weakness 0.48%, and nocturia 0.48%). 1.1% of subjects experienced hypoglycemia, and other 0.12% reported severe hypoglycemic events. Conclusion: Empagliflozin is effective, safe, and tolerable for treating Bangladeshi patients with uncontrolled T2DM as add-on therapy in routine clinical practice with favorable effects on body weight, BP, lipid profile, and renal function.

Introduction Globally, coronary heart disease is the most imperative cause of premature death. However, timely management with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) can improve the quality of life (QoL) and reduce mortality. The objective of this study was to evaluate the QoL between the patients who received PCI and CABG for the treatment of coronary heart disease. Materials and methods This was a retrospective observational study. Patients who underwent PCI or CABG at least three months before or more at enrollment were purposefully selected. Results A total of 156 patients were enrolled, 78 in each group. Health-related QoL was assessed by using the SF-36 scale for PCI or CABG procedures. The mean ± SD scores of QoL for PCI and CABG were 78.95 ±10.14 and 78.17 ± 10.92, respectively. Of the patients, 72.43% felt better after treatment, 17.95% felt the same as before treatment, and 9.62% felt worse than before treatment in both groups. Among CABG patients, 38.46% felt significantly better after treatment compared to PCI (33.97%) (p=0.048). Moreover, more CABG patients (6.41%) felt significantly worse than PCI patients (3.21%) after treatment (p=0.048). Male patients were significantly more in the CABG group (89.74%) compared to the PCI group (75.64%). In contrast, female patients had more PCI (24.36%) compared to CABG patients (10.26%) (p=0.020). Conclusion Subjective perceptions of physical and mental well-being improved significantly from before treatment to at least three months after treatment, and an enhanced health-related QoL was noticed for medical intervention (PCI) and surgical approach (CABG).

Free Open-Access Medical Education (FOAMed) has transformed medical education in the past decade by complementing and substituting for traditional medical education when needed. The attractiveness of FOAMed resources is due to their inexpensive nature, wide availability, and user ability to access on demand across a variety of devices, making it easy to create, share, and participate. The subject of nephrology is complex, fascinating, and challenging. Traditional didactic lectures can be passive and ineffective in uncovering these difficult concepts and may need frequent revisions. Active teaching methods like flipped classrooms have shown some benefits, and these benefits can only be multifold with current social media tools. Social media will inspire the involvement of students and allow them to create and share educational content in a "trendy way," encouraging the participation of their peers and thus building an educational environment more conducive to them while promoting revision and retainment. FOAMed also promotes asynchronous learning, spaced learning, microlearning, and multimodal presentation with a meaningful variation. This article discusses the evolution of digital education, social media platforms, tools for creating and developing FOAMed resources, and digital scholarship.

The global demand for water conservation and sustainability in textile manufacturing is imperative in addressing the scarcity of fresh water and environmental pollution. This study introduces an innovative water-saving process for exhaust dyeing of cotton fabrics with reactive dyes, without compromising the dyeing quality or requiring extra investments. Traditional textile dyeing practices consume approximately 120 liters of fresh water per kilogram of cotton fabric, contributing to environmental degradation. In this research, a process modification is proposed that recycles water used for neutralization and rinsing at the second step of the dyeing process. This recycled water is utilized in the fourth step, effectively reducing the total water consumption to 104 liters per kilogram of fabric, thus saving 16 liters per kilogram without any additional investment. The dyed fabrics produced using this water-saving process exhibit excellent colorfastness, matching the quality of conventionally dyed textiles. The color fastness to light, washing, rubbing, and perspiration meets international standards. CMC tests indicate no significant differences compared to the existing dyeing process. Implementing this eco-friendly approach can not only significantly reduce water consumption and wastewater generation but also diminish the need for costly water treatment and effluent management facilities. This research paves the way for cleaner production in the textile industry, promoting water conservation, reducing environmental pollution, and minimizing production costs.

This Quality Improvement Project (QIP) aimed to assess the acceptability and utility of the National Early Warning Score 2 (NEWS2) in a Bangladeshi level-2 care setting. All nurses and physicians were trained on NEWS2 scores and a proper response before starting the QIP. Utilization of NEWS2 and patient outcome were documented and analyzed. Acceptability was acknowledged by increase in utilization, and utility by reduction in unrecognized deterioration of patients. The modified NEWS2 was well adopted and utilized by the nursing staff. There was a statistically significant reduction in unrecognized deterioration leading to cardiac arrest and the need for transfer to the Intensive Care Unit after implementation of NEWS2. With adequate training, motivation and appropriate modification, NEWS2 can become a well-accepted, widely adopted and realistic bedside monitoring tool in resource-limited settings like Bangladesh.

Objectives: Underlying medical conditions are critical risk factors for COVID-19 susceptibility and its rapid clinical manifestation. Therefore, the preexisting burden of non-communicable diseases (NCDs) makes the preparedness for COVID-19 more challenging for low- and middle-income countries (LMICs). These countries have relied on vaccination campaigns as an effective measure to tackle COVID-19. In this study, we investigated the impact of comorbidities on humoral antibody responses against the specific receptor-binding domain (RBD) of SARS-CoV2. Methods: A total of 1005 patients were selected for the SARS-CoV-2 specific immunoglobulin G (IgG1, IgG2, IgG3, and IgG4 subclasses) and total antibody (TAb) tests (IgG and IgM), of which 912 serum samples were ultimately selected based on the specimen cutoff analyte value. Patients with multimorbidity (N = 60) were recruited for follow-up studies from the initial cohort, and their immune response (IgG and TAb) was measured at multiple time points after the second dose of vaccination. Siemens Dimension Vista SARS-CoV-2 IgG (CV2G) and SARS-CoV-2 TAb assay (CV2T) were used to carry out the serology test. Results: Out of a total of 912 participants, vaccinated individuals (N=711) had detectable antibody responses up to 7–8 months. The synergistic effect of natural infection and vaccine response was also studied. Participants with breakthrough infection (N=49) mounted greater antibody response compared to individuals with normal vaccination response (N=397) and those who were naturally infected before receiving the second dose of vaccine (N=132). Investigation of the impact of comorbidities revealed that diabetes mellitus (DM) (N= 17) and kidney disease (N=50) had a significant negative impact on the decline of the humoral antibody response against SARS-CoV-2. IgG and TAb declined more rapidly in diabetic and kidney disease patients compared to the other four comorbid groups. Follow-up studies demonstrated that antibody response rapidly declined within 4 months after receiving the second dose. Conclusion: The generalized immunization schedule for COVID-19 needs to be adjusted for high-risk comorbid groups, and a booster dose must be administered early within 4 months after receiving the second dose.

Free Open Access Medical Education (FOAMed) is successfully utilized by medical professionals worldwide to improve educational equity and networking opportunities. One such novel FOAMed tool is a Twitter-based journal club, #IPNAJC. The summary and infographics of selected pediatric nephrology article(s) are published on the IPNAJC website and emailed to members. Two separate, live, one-hour sessions are conducted in major international time zones in English and Spanish. Authors and experts are invited to the discussion. After #IPNAJC, a wrap-up is distributed across the IPNAJC membership via an email¸ for access on demand. An online, anonymous 11-question survey was distributed to IPNA members by email between Nov–Dec 2021. The response rate was 3.5 % (n=67). Most responses were from Asia (33%) and physicians (72%). Participants learned about #IPNAJC via email (69%), social media (17%), and colleagues (14%). Approximately 42% participated live; the remaining interacted with the materials asynchronously. The median (IQR) overall quality was 4 (3–5), the quality of summaries was 4 (4–5), VA usefulness was 5 (5), and ease of participation in the discussion was 5 (3–5). Analysis of Twitter chat revealed that 24 people participated in the live #IPNAJC, generating 424 tweets and 1.048 million impressions (median (IQR)). Most respondents perceived that the #IPNAJC and its FOAMed resources were of good quality. This survey study reinforces that FOAMed resources have a broad geographical reach, are accessed by users at all career stages, and can be utilized during and after a social media event.

Background: Pandrug-resistant Klebsiella pneumoniae ventilator associated pneumonia (VAP) is associated with high rate of mortality in intensive care unit (ICU) and has been recognized as a difficult-to-treat infection worldwide. Polymyxin B or colistin-based combination therapies are frequently used worldwide though microbial eradication rate is not promising. Aim: The aim of this study is to compare the clinical outcome of intravenous with aerosolized polymyxin B versus colistin in the treatment of pandrug-resistant K. pneumoniae VAP. Methods: This retrospective cohort study was conducted on 222 mechanically ventilated patients admitted from May 11, 2019 to October 19, 2020. K. pneumoniae isolates were resistant to all available antibiotics, including polymyxins in culture sensitivity tests. As treatment, polymyxin B and colistin was administered in intravenous and aerosolized form concurrently twice daily in 106 patients and 116 patients in PMB and CLN group, respectively for 14 days. Survival rate, safety, and clinical outcomes were compared among the groups. The Cox proportional-hazard model was performed to calculate hazard ratio (HR) with 95% confidence intervals (CI). Results: Patients in PMB group showed more microbial eradication than the patients CLN group [68.1% (n=116)/83% (n=106), respectively; P <0.05). The median day of intubation and ICU stay in PMB group was shorter than that in CLN group [10 (IQR: 9-12.25) vs. 14 (IQR: 11-19), P <0.05; 12 (IQR: 10-14) vs. 15 (IQR: 9-18.5), P=0.072, respectively] with reduced 60-day all-cause mortality rate [15% (n=106) vs. 21.55% (n=116)]. Polymyxin B improved survival compared to colistin (multivariate HR: 0.662; 95% CI=0.359- 1.222, P=0.195). Conclusions: Concurrent administration of intravenous and aerosolized polymyxin B in patients with pandrug-resistant K. pneumoniae-associated VAP revealed better microbial eradication, reduced the length of intubation and ICU stay, and improved survival rate compared to colistin.

Dialysis catheters are commonly used tools for patients requiring hemodialysis. A dilator with a large caliber is used to insert such a catheter, which in turn can result in serious vascular injury leading to rare complications like hemothorax. Common treatment options for such vascular injuries comprise surgical repair by thoracotomy or video-assisted thoracoscopic surgery (VATS) and endovascular repair. We herein report a case of a brachiocephalic vein injury and massive right-sided hemothorax following the insertion of a tunneled dialysis catheter in the right internal jugular vein, treated successfully by our team at Square Hospitals Ltd.

We investigate the impact of lung metastasis versus metastasis of bone, brain, or liver on overall survival (OS) and thyroid cancer-specific survival (TCSS) in patients with thyroid cancer (TC). Therefore, de-identified SEER 18 registry data of primary TC patients diagnosed between 2010 and 2016 were analyzed. The primary outcome was the prognosis of TC patients with lung metastasis compared with other sites. The secondary outcomes included the prognosis comparison between patients with and without surgery and between single and multiple metastasis sites. Isolated lung metastasis was associated with worse OS and TCSS than bone metastasis (both p < 0.05) and was associated with worse OS than liver metastasis (p = 0.0467). Surgery performed either for the primary or distant site was associated with better OS and TCSS in patients with metastasis of lung or bone (p < 0.05). Isolated lung metastasis was related to better OS and TCSS than lung–liver, lung–brain, and lung–other multiple metastases. The multivariable analysis revealed that age <55 years, surgery to the primary site, and to the distant site(s) were associated with better outcomes, while T4 and Tx were associated with worse outcomes. Nevertheless, it revealed that the other race (i.e., any race other than white, black, or unknown) and male gender were associated with better TCSS only (p < 0.05). Isolated lung metastasis is associated with a worse prognosis in TC patients compared with bone or liver metastasis. Surgery performed either for the primary or distant site(s) is associated with better survival outcomes in TC patients with metastasis of lung or bone.

Sepsis is a life-threatening condition that causes a global health burden associated with high mortality and morbidity. Often life-threatening, sepsis can be caused by bacteria, viruses, parasites or fungi. Sepsis management primarily focuses on source control and early broad-spectrum antibiotics, plus organ function support. Comprehensive changes in the way we manage sepsis patients include early identification, infective focus identification and immediate treatment with antimicrobial therapy, appropriate supportive care and hemodynamic optimization. Despite all efforts of clinical and experimental research over thirty years, the capacity to positively influence the outcome of the disease remains limited. This can be due to limited studies available on sepsis in developing countries, especially in Southeast Asia. This review summarizes the progress made in the diagnosis and time associated with sepsis, colistin resistance and chloramphenicol boon, antibiotic abuse, resource constraints and association of sepsis with COVID-19 in Southeast Asia. A personalized approach and innovative therapeutic alternatives such as CytoSorb® are highlighted as potential options for the treatment of patients with sepsis in Southeast Asia.

Introduction Invasive candidiasis (IC) in critically ill patients is a serious infection with high rate of mortality. As an empirical therapy, like antibiotics, the use of antifungals is not common in intensive care units (ICUs) worldwide. The empirical use of echinocandins including anidulafungin is a recent trend. Aim of the study The objective of this study was to assess the impact of empirical anidulafungin in the development of invasive candidiasis in critically ill patients in ICU. Methods This retrospective case-control study was conducted on 149 patients with sepsis with/without septic shock and bacterial pneumonia. All the patients were divided into two groups. The ‘control group’ termed as ‘NEAT group’ received no empirical anidulafungin therapy and the ‘treated group’ termed as ‘EAT group’ received empirical anidulafungin therapy in early hospitalization hours. Results Seventy-two and 77 patients were divided into the control and the treated group, respectively. Patients in EAT group showed less incidences of IC (5.19%) than that of the NEAT group (29.17%) (p = 0.001). Here, the relative risk (RR) was 0.175 (95% CI, 0.064-0.493) and the risk difference (RD) rate was 24% (95% CI, 12.36%-35.58%). The 30-day all-cause mortality rate in NEAT group was higher (19.44%) than that of in EAT group (10.39%) (p = 0.04). Within the first 10-ICU-day, patients in the EAT group left ICU in higher rate (62.34%) than that in the NEAT group (54.17%). Conclusion Early empirical anidulafungin within 6 h of ICU admission reduced the risk of invasive candidiasis, 30-day all-cause mortality rate and increased ICU leaving rate within 10-day of ICU admission in critically ill patients.