Measuring the effectiveness of an integrated intervention package to improve the level of infection prevention and control: a multi-centre study in Bangladesh.

BACKGROUND: Infection prevention and control (IPC) is a critical component of delivering safe, effective and high-quality healthcare services, and eliminating avoidable healthcare-associated infections (HAIs) in health facilities, predominantly in population-dense settings such as Bangladesh. AIM: Our study aimed to assess the effect of an integrated intervention package in improving the IPC level of the health facilities in Bangladesh. METHODS: We conducted a pre-post intervention study in six district hospitals (DHs) and 13 Upazila Health Complexes (UHCs) in the six districts of Bangladesh. Baseline and endline assessments were conducted between March and December 2021 using the adapted World Health Organization Infection Prevention and Control Assessment Framework (WHO-IPCAF) tool. The IPCAF score, ranging from 0-800, was calculated by adding the scores of eight components, and the IPC promotion and practice level was categorized as Inadequate (0-200), Basic (201-400), Intermediate (401-600) and Advanced (601-800). The integrated intervention package including IPC committee formation, healthcare provider training, logistics provision, necessary guidelines distribution, triage/flu corners establishment, and infrastructure development was implemented in all facilities. RESULTS: The average IPCAF score across all the facilities showed a significant increase from 16% (95% CI: 11.5-20.65%) to 54% (95% CI: 51.4-57.1%). Overall, the IPCAF score increased by 34 percentage points (P<0.001) in DHs and 40 percentage points (P<0.001) in UHCs. Following the intervention, 12 (three DHs, nine UHCs) of 19 facilities progressed from inadequate to intermediate, and another three DHs upgraded from basic to intermediate in terms of IPC level. CONCLUSION: The integrated intervention package improved IPCAF score in all facilities.

Malathion-Induced Hematoxicity and Its Recovery Pattern in Barbonymus gonionotus.

An experiment was conducted to assess malathion-induced hematological responses of Barbonymus gonionotus (silver barb) and its recovery patterns in malathion-free water. Fish (45 days old) were exposed to two sublethal concentrations, namely, 25% and 50% (i.e., 3.78 and 7.56 ppm) of LC50 (15.13 ppm) of malathion for 28 days, followed by a postexposure recovery period for the same time. The hematological parameters were examined after 1, 7, 14, 21, and 28 days of exposure as well as after the postexposure recovery time. Except in the case of the control group (0% of malathion), the obtained results revealed that malathion exposure resulted in significantly (p < 0.05) higher prevalence and severity of micronucleus and lower values of Hb, PCV, and RBC and significantly higher values of WBC in a concentration- and time-dependent manner. The values of blood glucose, MCV, MCH, and MCHC showed mixed trends during the experiment. During the recovery period, all blood parameters (micronucleus, glucose, Hb, PCV, RBC, WBC, MCV, MCH, and MCHC) partially recovered, which means that the recovery period was not long enough for the organisms to recover from the previous exposure. The study thus confirms that hematology is a sensitive indicator for fish to detect toxicity caused by different chemicals. Changes in these parameters can provide useful information about environmental conditions and risk assessment of aquatic organisms.

Malaysian mental health law.

The Malaysian Mental Health Act 2001 did not come into effect until the Mental Health Regulations 2010 came into force. The Act provides a framework for the delivery of comprehensive care, treatment, control, protection and rehabilitation of those with mental disorders. The Act governs the establishment of private and government psychiatric hospitals, psychiatric nursing homes and community mental health centres. This paper outlines the provisions of the Act and the Regulations.

Simple gas chromatographic method for the quantification of total cholesterol in fish meats.

Six fish species-Cirrhinus mrigala (Morakhi), Labeo rohita (Danbhro), Catla catla (Thalli), Wallago attu (Jarko), Ctenopharyngodon idella (Grass), and Cyprimus carpio (Gulfam)--commonly found in the Pakistani Indus river, were selected for fat and cholesterol evaluation. Fat content was quantified by the Folch method and cholesterol content was determined by a simple GC method. The application of the proposed method to quantify cholesterol content revealed variations among the six breeds evaluated. The breeds studied contained 0.80-1.95% fat, indicating that all investigated fishes were lean; significant variation was found in cholesterol content, and ranged between 72 and 392 mg/100 g. Standard addition analyses showed that the method was accurate, as the recovery of cholesterol varied from 95 to 103%, with a coefficient of variance not more than 5.6%. The results showed that, after the development of suitable calibration, within 11 min, the cholesterol could be accurately determined by GC.

When a nephrectomy cures hypoglycaemia.

A 40-year-old woman presented with a 10 day history of episodic vagueness, speech disturbance and blurred vision. Episodes typically occurred in the morning after awaking from sleep and resolved with food ingestion. She had no past medical history, did not drink alcohol and was not on any medication. Physical examination was normal with no evidence of endocrinopathy. After 10 h of fasting, she became hypoglycaemic with evidence of neuroglycopenia, which resolved with intravenous dextrose. Biochemical investigations revealed decreased glucose, insulin and C-peptide values with an increased excess insulin-like growth factor II: excess insulin-like growth factor I (IGF-II: IGF-I) ratio. Radiological examinations of the abdomen and pelvis revealed a heterogenous 10.5 cm left renal mass. The patient underwent a radical left nephrectomy. She had complete resolution of hypoglycaemic events. Histology revealed a renal sarcoma, grade 2/3. This is the first report in the literature involving a renal sarcoma causing non-islet cell tumour hypoglycaemia via excess IGF-II secretion.

Hematopoietic stem cell transplantation in Oman.

Hematopoietic SCT (HSCT) is an integral part of the management of patients with hematologic disorders. The Sultanate of Oman, with a population of 2.3 million, has an HSCT program based in the Sultan Qaboos University (SQU) hospital. Initiated in 1995, this two-bed unit continues to be the only program in the country. Between June 1995 and August 2006, a total of 128 patients underwent HSCT in this center, averaging about 10-12 transplants per year. The median age of these patients was 11 years (2 months to 45 years). Hematologic malignancies (49%) and inherited disorders (42%) constituted the major transplant indications, whereas BM failure accounted for the remaining. The majority of transplants carried out so far have been HLA-matched sibling-donor allogeneic HSCTs. Among the inherited disorders, homozygous beta-thalassemia and primary immunodeficiency are important transplant indications in this center. The approximate cost of an uncomplicated transplant in this center is US$50,000. The success of this program has now led to the initiation of a new and larger HSCT complex to provide the opportunity for more patients to benefit from this treatment modality within the country.