Antibiotic usage patterns in COVID-19 patients in five tertiary hospitals from Bangladesh: A countrywide picture.

Objectives: Irrational and injudicious use of antibiotics in COVID-19 patients could be detrimental in a tropical country with a weak antibiotic stewardship policy such as Bangladesh. This study aimed to focus on the antibiotic usage patterns in COVID-19 patients in Bangladesh. Methods: This prospective observational study was performed from July 2020 to June 2021 in five tertiary hospitals in Bangladesh. Data on demographic profile, disease severity, and antibiotic usage were collected directly from the patients' hospital documents. Results: A total of 3486 (94.4%) patients were treated with at least one antibiotic; 3261 (93.6%) patients received a single antibiotic, and 225 (6.5%) received multiple antibiotics. The most used antibiotics were ceftriaxone (37.3%), co-amoxiclav (26.3%), azithromycin (10.6%), and meropenem (10.3%). According to the World Health Organization AWaRe categorization, most (2260; 69.6%) of the antibiotics prescribed in this study belonged to the "Watch" group. Culture and sensitivity reports were available in 111 cases from one center. Only 18.9% of the patients were found to be co-infected with multi-drug-resistant bacteria (52.4% yield from sputum, 28.6% from urine, and 14.3% from blood). Conclusions: Strict antibiotic prescribing policy and antibiotic stewardship should be implemented immediately to limit the future threat of antimicrobial resistance in countries such as Bangladesh.

Trend of soil salinization in Africa and implications for agro-chemical use in semi-arid croplands.

Soil salinization is a gradual degradation process that begins as a minor problem and grows to become a significant economic loss if no control action is taken. It progressively alters the soil environment which eventually negatively affects plants and organism that were not originally adapted for saline conditions. Soil salinization arises from diverse sources such as side-effects of long-term use of agro-chemicals, saline parent rocks, periodic inundation of soil with saline water, etc. In Africa, soil salinization has not been adequately documented particularly in the croplands. The objective of this study was to identify trends of cropland salinization in Africa and how its relationship with long-term land use practices affected the soil environment. The study analysed soil salinization between 1965 and 2020 using measured electrical conductivity (EC), spatial modelling with environmental covariates, and national statistics on cropland expansion and application of mineral fertilizers, herbicides, and pesticides. The results showed increasing trends of EC in Africa due to climatic and land use drivers. Increasing trends of EC, which evidenced salinization, was found in 31 million hectares of topsoils and 18 million hectares of subsoils. About 2 million hectares of croplands were depicted with salinization and >25 million hectares at the risk of salinization in the arid and semi-arid areas. The study also found statistical relationships between semi-arid cropland salinization and trends of agro-chemical use and cropland sizes. There were significant (p < 0.001) positive correlations between semi-arid cropland salinization and trends of cropland expansion and applied nitrogenous fertilizers. It found that increasing trend of applied mineral nitrogenous fertilizers could double the odds of salinization in semi-arid croplands while cropland expansion could increase the odds of semi-arid cropland salinization by >10 %. These findings present ground-breaking baseline information for future works on sustainable land-use practices that can control cropland soil salinization in Africa.

Isolated porta hepatis metastasis of papillary thyroid cancer.

Metastases from differentiated thyroid cancer are usually seen in the cervical or mediastinal lymph nodes, lung or bone. We report a case of papillary thyroid cancer metastasizing to lymph nodes in the porta hepatis. No other site of metastasis was apparent on neck or abdominal exploration or on iodine whole-body scans. The primary tumor was a multifocal papillary thyroid cancer arising on a background of multinodular goiter. The metastasis was observed on a diagnostic radioiodine scan after surgical resection of the primary tumor despite significant (11%) radioiodine uptake by residual thyroid tissue in the neck and was proven by histologic examination and thyroglobulin immunohistochemistry. Although rare, metastasis to porta hepatis lymph nodes should be considered in the differential diagnosis of abdominal radioiodine uptake in patients with differentiated thyroid cancer.

Measurement of erythrocyte deformability using a stroboscopic recording centrifuge.

A stroboscopic recording centrifuge technique is described which can measure deformability of red blood cells in terms of the rate of packing at low g. It can be used to measure several whole blood samples simultaneously, with accurate control of the speed of rotation and recording time. Only 0.05 ml of blood is required per measurement, and no prior treatment or preparation of the sample is necessary. The calibration procedures to allow for variations of the haematocrit and plasma fibrinogen level are explained.

Breast abscess caused by Brucella melitensis.

Cutaneous and soft tissue lesions are uncommon manifestations of brucellosis. Though breast involvement in animal brucellosis is not uncommon, involvement of the breast in human brucellosis is extremely rare. We report a case of breast abscess in a 39-year-old female caused by Brucella melitensis. Treatment with combination of trimethoprim/sulphamethoxazole (TMP/ SMX; cotrimoxazole) and doxycycline for 3 months resulted in clinical cure.

Effects of warfarin on blood rheology in navicular disease.

A preliminary investigation has been undertaken of blood rheology in horses and ponies, its variation in navicular disease and the changes following treatment with warfarin. Erythrocyte flexibility, measured by a centrifuge packing technique, is higher in horses (30 per cent min-1) than in ponies (23.8 per cent min-1). There are corresponding differences in blood viscosity. The high erythrocyte flexibility in horses is caused by an unknown factor present in plasma. The erythrocyte flexibility in horses with navicular disease is even higher, at 38.5 per cent min-1. Treatment with warfarin reduces the flexibility to just below the normal value. A significant fall in plasma viscosity and erythrocyte flexibility was found after treatment of four ponies with 6 mg warfarin daily for one week.

Abdominal wall necrosis and disruption in a seat belt injury.

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The blood rheology of man and various animal species.

A comparative study has been made of the blood rheology, and its component factors, in horse, sheep, cattle, goat, camel, pig, dog, rabbit and man. The erythrocyte flexibility of horse red cells is high relative to man, that of pig, dog, camel and rabbit comparable, but less flexible, and sheep, cattle and goat relatively inflexible. The erythrocyte flexibility of horse, sheep, cattle and goats does not vary with the plasma fibrinogen level, as occurs with human and rabbit cells. Washing erythrocytes and then suspending them in isotonic saline makes the erythrocytes of all species relatively inflexible. There is a factor in horse plasma, which is not fibrinogen, that makes horse and human erythrocytes suspended in it very flexible. The blood viscosity of all species is comparable at high shear rates (230 s-1) due to the shape of the cells compensating for their flexibility. The variations of blood viscosity at low shear rates (11.5 s-1) were also found to depend on the erythrocyte flexibility, and only influenced indirectly by the fibrinogen concentration. There is no significant effect of temperature on the erythrocyte flexibility of horse, sheep, cattle, goat and a small number of human subjects. This is reflected in the way the viscosity of these bloods varies with temperature.