Acetaminophen as a Renoprotective Adjunctive Treatment in Patients With Severe and Moderately Severe Falciparum Malaria: A Randomized, Controlled, Open-Label Trial.

Background: Acute kidney injury independently predicts mortality in falciparum malaria. It is unknown whether acetaminophen's capacity to inhibit plasma hemoglobin-mediated oxidation is renoprotective in severe malaria. Methods: This phase 2, open-label, randomized controlled trial conducted at two hospitals in Bangladesh assessed effects on renal function, safety, pharmacokinetic (PK) properties and pharmacodynamic (PD) effects of acetaminophen. Febrile patients (>12 years) with severe falciparum malaria were randomly assigned to receive acetaminophen (1 g 6-hourly for 72 hours) or no acetaminophen, in addition to intravenous artesunate. Primary outcome was the proportional change in creatinine after 72 hours stratified by median plasma hemoglobin. Results: Between 2012 and 2014, 62 patients were randomly assigned to receive acetaminophen (n = 31) or no acetaminophen (n = 31). Median (interquartile range) reduction in creatinine after 72 hours was 23% (37% to 18%) in patients assigned to acetaminophen, versus 14% (29% to 0%) in patients assigned to no acetaminophen (P = .043). This difference in reduction was 37% (48% to 22%) versus 14% (30% to -71%) in patients with hemoglobin ≥45000 ng/mL (P = .010). The proportion with progressing kidney injury was higher among controls (subdistribution hazard ratio, 3.0; 95% confidence interval, 1.1 to 8.5; P = .034). PK-PD analyses showed that higher exposure to acetaminophen increased the probability of creatinine improvement. No patient fulfilled Hy's law for hepatotoxicity. Conclusions: In this proof-of-principle study, acetaminophen showed renoprotection without evidence of safety concerns in patients with severe falciparum malaria, particularly in those with prominent intravascular hemolysis. Clinical Trials Registration: NCT01641289.

"We do not go outside, though We want to": Unequal Access to Public Transport and Transport-Related Social Exclusion of Older Adults in Dhaka, Bangladesh.

This study investigated key physical and social barriers to accessing public transport in Dhaka, Bangladesh, and how the unequal accessibility of transport leads to the social exclusion of older adults. Employing a transport disadvantage perspective and drawing on visual surveys and in-depth interviews, the study explores the context and lived experiences of older adults using public transport in their everyday lives. Difficulty in accessing buses due to overcrowding and congestion, struggling to get on rickshaws due to height, avoiding CNG (an autorickshaw) and cabs due to high fares, disliking Laguna (a small four-wheeler human haulier for carrying passengers) for compact seating arrangements, undesirable behavior, and social attitudes discourage older adults from participating in social activities and produce a feeling of social isolation and exclusion. Hence, more inclusive transport policies are essential in low- and middle-income countries to reduce transport-related social exclusion and improve the well-being of older adults.

"When I Need to Travel, I Feel Feverish": Everyday Experiences of Transport Inequalities Among Older Adults in Dhaka, Bangladesh.

BACKGROUND AND OBJECTIVES: Buses are the most common form of public transport for older adults in developing countries. With over 37% of total trips, buses are the principal mode of transport in Dhaka. The majority of older adults are dependent on buses because of their affordability relative to other modes such as auto-rickshaws, rideshares, and taxis. This study aims to investigate key barriers in accessing buses in Dhaka and the consequences of these barriers to the everyday mobility of older adults. RESEARCH DESIGN AND METHODS: Thirty participants aged 60 and older were recruited from 2 socioeconomically different neighborhoods in Dhaka. We employed a thematic analysis of visual surveys and in-depth interviews to understand older adults' spatial and cultural context and their experiences using buses in their everyday lives. RESULTS: Boarding and deboarding buses were common barriers for older adults due to overcrowding and traffic congestion. In addition, older adults faced challenges such as ageism, gender discrimination, and undesirable behavior by transport personnel and co-passengers. These barriers affected their independent mobility and influenced their access to work and social life, contributing to their social exclusion. DISCUSSION AND IMPLICATIONS: This study illustrates the challenges faced by older adults when accessing public transport and the need to improve access to work, health care, and social life. Inclusive transport policies are essential in low- and middle-income countries to improve the well-being of older adults.

COVID-19's lockdown effect on air quality in Indian cities using air quality zonal modeling.

The complete lockdown due to COVID-19 pandemic has contributed to the improvement of air quality across the countries particularly in developing countries including India. This study aims to assess the air quality by monitoring major atmospheric pollutants such as AOD, CO, PM2.5, NO2, O3 and SO2 in 15 major cities of India using Air Quality Zonal Modeling. The study is based on two different data sources; (a) grid data (MODIS- Terra, MERRA-2, OMI and AIRS, Global Modeling and Assimilation Office, NASA) and (b) ground monitoring station data provided by Central Pollution Control Board (CPCB) / State Pollution Control Board (SPCB). The remotely sensed data demonstrated that the concentration of PM2.5 has declined by 14%, about 30% of NO2 in million-plus cities, 2.06% CO, SO2 within the range of 5 to 60%, whereas the concentration of O3 has increased by 1 to 3% in majority of cities compared with pre lockdown. On the other hand, CPCB/SPCB data showed more than 40% decrease in PM2.5 and 47% decrease in PM10 in north Indian cities, more than 35% decrease in NO2 in metropolitan cities, more than 85% decrease in SO2 in Chennai and Nagpur and more than 17% increase in O3 in five cities amid 43 days pandemic lockdown. The restrictions of anthropogenic activities have substantial effect on the emission of primary atmospheric pollutants.