BackgroundUnder-five mortality is unacceptably high in Bangladesh instead of governmental level efforts to reduce its prevalence over the years. Increased availability and accessibility to the health ...care facility and its services can play a significant role to reduce its occurrence. We explored the associations of several forms of child mortality with health facility level factors.MethodsThe 2017-18 Bangladesh Demographic and Health Survey (BDHS) data and 2017 Bangladesh Health Facility Survey (BHFS) data were linked and analysed. The outcome variables were neonatal mortality, infant mortality, and under-five mortality. Health facility level factors were considered as major explanatory variables. They were the basic management and administrative system of the nearest health care facility where child health care services are available, degree of availability of the child health care services at the nearest health care facility, degree of readiness of the nearest health care facility (where child health care services are available) to provide child health care services and average distance of the nearest health care facility from mothers’ homes where child health care services are available. The associations between the outcome variables and explanatory variables were determined using the multilevel mixed-effect logistic regression model.ResultsReported under-five, infant and neonatal mortality were 40, 27, and 22 per 10 000 live births, respectively. The likelihood of neonatal mortality was found to be declined by 15% for every unit increase in the score of the basic management and administrative system of the mothers’ homes nearest health care facility where child health care services are available. Similarly, degree of availability and readiness of the mothers’ homes nearest health care facilities to provide child health care services were found to be linked with 18%-24% reduction in neonatal and infant mortality. On contrary, for every kilometre increased distance between mothers’ homes and its nearest health care facility was found to be associated with a 15%-20% increase in the likelihoods of neonatal, infant and under-five mortality.ConclusionsThe availability of health facilities providing child health care services close to mothers’ residence and its readiness to provide child health care services play a significant role in reducing under-five mortality in Bangladesh. Policies and programs should be taken to increase the availability and accessibility of health facilities that provide child health care services.
Summary
Primary breast diffuse large B‐cell lymphoma (DLBCL) is a rare subtype of non‐Hodgkin lymphoma (NHL) with limited data on pathology and outcome. A multicentre retrospective study was ...undertaken to determine prognostic factors and the incidence of central nervous system (CNS) relapses. Data was retrospectively collected on patients from 8 US academic centres. Only patients with stage I/II disease (involvement of breast and localized lymph nodes) were included. Histologies apart from primary DLBCL were excluded. Between 1992 and 2012, 76 patients met the eligibility criteria. Most patients (86%) received chemotherapy, and 69% received immunochemotherapy with rituximab; 65% received radiation therapy and 9% received prophylactic CNS chemotherapy. After a median follow‐up of 4·5 years (range 0·6–20·6 years), the Kaplan–Meier estimated median progression‐free survival was 10·4 years (95% confidence interval CI 5·8–14·9 years), and the median overall survival was 14·6 years (95% CI 10·2–19 years). Twelve patients (16%) had CNS relapse. A low stage‐modified International Prognostic Index (IPI) was associated with longer overall survival. Rituximab use was not associated with a survival advantage. Primary breast DLBCL has a high rate of CNS relapse. The stage‐modified IPI score is associated with survival.
We present a case of a patient with cutaneous T-cell lymphoma started on bexarotene 300 mg/m2 due to progressing disease. The patient experienced good clinical response, but unfortunately, she ...developed rapid and profound hypertriglyceridemia. Although hypertriglyceridemia occurs in high incidence with bexarotene therapy, management recommendations are scarce. Due to the rise in triglycerides, atorvastatin 10 mg daily was initiated in combination with fenofibrate 120 mg daily. Triglycerides continued to increase, so the patient was instructed to take atorvastatin 40 mg, fenofibrate 120 mg, and to hold bexarotene for 2 weeks. After the 2-week break, bexarotene was restarted at 150 mg/m2.
The Belai beel serves as an important aquatic resource for the livelihood of the local community of the Gazipur district in Bangladesh. However, water pollution in recent times, mainly from ...industrial wastes and sewage effluents, may disrupt its aquatic environment. Thus, the purpose of the present study was to assess the potential area of pen fish culture in the Belai beel. The study was performed in the Rajbagan (L1), Kamaria (L2) and Rewla (L3) areas of the Belai beel. Grass carp, silver carp, common carp, catla and rui of 20–30 cm in size were stocked at a rate of 15,000 fish/ha and reared for 150 days in pens installed in the L1, L2 and L3 areas, respectively. The fishes were fed with mustard oil cake and rice bran. Maximum fish production was found in Rewla (12.97 ton/ha/150 days) compared to Rajbagan (8.85 ton/ha/150 days) and Kamaria (10.67 ton/ha/150 days) due to it having comparatively good quality water. There were significant differences in metal ion concentrations (p < 0.05) among the three fish pens. In the Rajbagan area, concentrations of Cd and Cu in the water coming from the industrial effluent canal exceeded the acceptable limit. Results indicated that the Rewla area was better than Rajbagan and Kamaria due to it having relatively good quality water for pen fish culture.
Background. While 2% of all extranodal Non-Hodgkin Lymphomas present in the thyroid, there exists insufficient data to describe the incidence of mantle cell lymphoma in the thyroid. A case series of ...1400 patients revealed that <1% of thyroid lymphomas may be MCL; hence better understanding of the disease course is essential. Patient Findings. A 65-year-old female was referred for a multinodular goiter. Multiple fine needle aspirations from the dominant right nodule were consistent with Hashimoto’s thyroiditis and flow cytometry was negative. Due to progressing dysphagia, she underwent total thyroidectomy. Summary. Pathology revealed MCL with mantle zone growth pattern in the right thyroid. Flow cytometry showed monoclonal B cells comprising 9% of total cells. The Ki-67 index was 10%. She was diagnosed as having stage IIE MCL and offered conservative management by medical oncology, given that she had no B symptoms. Conclusion. Though chemotherapy is the treatment of choice in MCL, a subset of patients with low-grade disease may be observed. As in our patient, mantle zone growth pattern and a Ki-67 index < 10% suggest a favorable prognosis. A diagnosis of primary MCL in the thyroid remains rare and staging modalities as well as treatment options continue to evolve.
Background: The motive of this observe is to compare the consequences of acute number one repair of extraarticular ligaments with staged surgical treatment for acute knee dislocations (KDs) and ...multiligament knee injuries (MLKIs). Materials and methods: The atudy has conducted in Department of Orthopedic, UHC sadar, Mymensingh. During the period of January 2013 and May 2021, 67 consecutive patients identified with MLKI or KD have been noted or visited our institution. Of these, 37 sufferers who underwent acute restore of extraarticular ligaments inside three weeks of damage had been included on this observe. These patients were retrospectively categorised into two corporations: people who underwent best primary repair (repair group) and people who underwent staged reconstructive surgical operation (staged group). Follow-up exam protected range of motion (ROM), knee joint balance (Lachman test, posterior drawer take a look at, and varus and valgus stress test), Lysholm knee score, Tegner interest scale, and Knee damage and Osteoarthritis and effect Score (KOOS). Results: Twelve of the 37 sufferers did not want or preference similarly surgical treatment and were protected inside the restore institution. No great distinction becomes determined in demographic facts among the restore and staged businesses. Although staged surgery decreased high-quality posterior drawer check results, no giant difference became located between the 2 businesses concerning ROM, different knee joint balance tests, Lysholm rankings, Tegner scale, or KOOS. Conclusions: all patients lower back to their activities of each day residing and preinjury career ranges. Acute primary restore of extraarticular ligaments gives critical knee stability without varus/valgus instability and may lessen the need for next cruciate ligament reconstruction.
The Internet of Things (IoT) integrates billions of self-organized and heterogeneous smart nodes that communicate with each other without human intervention. In recent years, IoT based systems have ...been used in improving the experience in many applications including healthcare, agriculture, supply chain, education, transportation and traffic monitoring, utility services etc. However, node heterogeneity raised security concern which is one of the most complicated issues on the IoT. Implementing security measures, including encryption, access control, and authentication for the IoT devices are ineffective in achieving security. In this paper, we identified various types of IoT threats and shallow (such as decision tree (DT), random forest (RF), support vector machine (SVM)) as well as deep machine learning (deep neural network (DNN), deep belief network (DBN), long short-term memory (LSTM), stacked LSTM, bidirectional LSTM (Bi-LSTM)) based intrusion detection systems (IDS) in the IoT environment have been discussed. The performance of these models has been evaluated using five benchmark datasets such as NSL-KDD, IoTDevNet, DS2OS, IoTID20, and IoT Botnet dataset. The various performance metrics such as Accuracy, Precision, Recall, F1-score were used to evaluate the performance of shallow/deep machine learning based IDS. It has been found that deep machine learning IDS outperforms shallow machine learning in detecting IoT attacks.
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