Study on the efficacy of ceftriaxone versus azithromycin for the treatment of uncomplicated enteric fever among the patients admitted in a tertiary level hospital

Background: Typhoid fever is a severe debilitating and potentially life threating illness. In Bangladesh, typhoid fever is a round the year problem which sometimes take epidemic proportions. The reasons behind such occurrences are unsafe water supply, defective sewage system and unhygienic food handling practice. This study aimed to compare the efficacy of ceftriaxone and azithromycin in the treatment of uncomplicated enteric fever.Methods: An observational study was conducted at the department of pharmacology in Dhaka medical college, Dhaka, Bangladesh. Data were collected from blood culture positive patients for Salmonella typhi and Salmonella paratyphi, who admitted in the Dhaka medical college and hospital, Dhaka during the period of July 2015 to June 2016. Data was collected by using a structured questioner, face to face interview, physical examination and investigation reports. Patients were hospitalized during the entire treatment period and at admission evaluation was made by history and physical examination in a structured format. Subjects ware asked regarding changes in symptoms and possible adverse effects of the study drugs. All patients were asked to return two weeks after completion of treatment for follow up. Blood culture of Salmonella typhi or Salmonella paratyphi were done in all cases. Total 91 patients were culture positive for either S. typhi or S. paratyphi which were finally studied.Results: During the study period out of 91 patients, 51 were receiving ceftriaxone and 40 were receiving azithromycin. Clinical cure was achieved in 46 patients (90%) of ceftriaxone group and in 31 patients (78%) in the azithromycin group. There were no significant differences of clinical cure between both treatment groups (p>0.05). Mean fever clearance time in ceftriaxone group was 3±1.4 days and was 4±1.6 days for azithromycin group. Difference in fever clearance time was statistically significant (p<0.05). No clinical relapses were detected in any study subject. No major side effects of both drugs occurred in any subject.Conclusions: These results indicated that both ceftriaxone and azithromycin were effective against enteric fever caused by sensitive organisms and multi drug resistant S. typhi and S. paratyphi. It is concluded that ceftriaxone is more effective and can be a convenient alternative for the treatment of enteric fever, especially in developing countries like us where medical resources are scarce.

The Impact of Uncertainty on Pedestrians’ Decision to Start Roadway Crossing during the Clearance Phase

Clearance phase at signalized crosswalks is an important parameter of pedestrians’ safety because it helps them to complete the crossing before the green signal for vehicles. However, there is the issue of pedestrian decision as to whether to cross if they arrive at the crosswalk during the clearance phase, which represents a violation in many countries. Due to the proof that pedestrian violations multiply the risk of traffic accidents, in this study, the tendency of pedestrians to commit violations during the clearance time has been researched. With the aim of proposing the design of the pedestrian traffic lights, which could decrease the frequency of pedestrian violations, the comparison of pedestrians behaviour at crosswalks with and without a countdown timer during the clearance time was made, based on the data collected in the video recording. Chi square independency test showed that there is a statistically significant difference in the behaviour of pedestrians during the clearance time, depending on the existence of the timer, as well as the fact that pedestrians behave in a safer manner if there is no clearance time shown on the timer. The total delay rate on the roadway during the red signal, which was the consequence of starting the crossing during the clearance time or subsequent violations, was 1.3 times higher at the crosswalks with the countdown timer. This research was unique because for the first time, two-phase pedestrian crossings on the roadway with the median refuge island in the sense of clearance time were analysed, in spite of the previous proof that pedestrians are more likely to commit violations during the red signal in that kind of roadway. Another novelty in the research was pedestrians following till the end of crossing, due to the possibility of subsequent violations. With the means of binary logistic regression, different factors which affect pedestrians’ behaviour during the clearance time have been determined and they differ depending on the existence of the timer. At the pedestrian crosswalks with the timer, contributing factors have been determined, such as gender, the number of waiting pedestrians, distractions, arrival time, and age. If there is no timer, the contributing factors are the following: the number of crossing pedestrians, distractions, group, position of pedestrians in relation to the vehicle, the number of traffic lanes, and age. Based on the obtained results, a new design of the pedestrian traffic lights was proposed.

Plasmodium falciparum clearance time in Malawian children with cerebral malaria: a retrospective cohort study

Background Standard treatment for both uncomplicated and severe malaria is artemisinin derivatives. Delayed parasite clearance times preceded the appearance of artemisinin treatment failures in Southeast Asia. Most worldwide malaria cases are in sub-Saharan Africa (SSA), where clinically significant artemisinin resistance or treatment failure has not yet been detected. The recent emergence of a resistance-conferring genetic mutation in the Plasmodium falciparum parasite in Africa warrants continued monitoring throughout the continent. Methods An analysis was performed on data from a retrospective cohort study of Malawian children with cerebral malaria admitted between 2010 and 2019 to a public referral hospital, ascertaining parasite clearance times across years. Data were collected from patients treated for severe malaria with quinine or artesunate, an artemisinin derivative. Parasite density was determined at admission and every subsequent 6 h until parasitaemia was below 1000 parasites/µl.The mean parasite clearance time in all children admitted in any one year was compared to the parasite clearance time in 2014, the first year of artesunate use in Malawi. Results The median population parasite clearance time was slower from 2010 to 2013 (quinine-treated patients) compared to 2014, the first year of artesunate use in Malawi (30 h (95% CI: 30–30) vs 18 h (95% CI: 18–24)). After adjustment for admission parasite count, there was no statistically significant difference in the median population parasite clearance time when comparing 2014 with any subsequent year. Conclusion Malaria parasite clearance times in Malawian children with cerebral malaria remained constant between 2014 and 2019, arguing against evolving artemisinin resistance in parasites in this region.

Impact of Privatization on Airlines

The purpose of this paper is to study and identify the factors such Boarding and clearance time, Ease of E-ticketing and luggage capacity and their effect on Customer Preference in the airline. This study examines the underlying forces of service quality influences on passenger’s satisfaction in aircraft transport. The study examines which dimensions have a positive influence on service quality and which dimensions have the most and least important impact on service quality in international air travel, as perceived by airline passengers, thereby ultimately targeting maximum monetary benefits. It is a qualitative research based on subjective examination of behavior, attitude & impressions. The simplification of research support is mainly based on group discussion of respondents. The data was collected through a Focused Group Discussion. Two FGD’s each consisting of 10 participants were recorded. The findings show that how the customers preferred one airline to others because of its quality, pricing and technology and frequency of flights. The participants talked much in depth about the quality and the treatment by staff inside the airplane. They also mentioned the details about the slowdown and fallout of the airline sector in India. The limitations are that it is constraint only to Mumbai. The participants lacked knowledge of the working of the airline industry as they did not travel frequently through airplanes. Keywords: Quality, Preference, Technology, Pricing, and Punctuality

Pyronaridine-Artesunate (Pyramax®) for the Treatment of Artemisinin- and Piperaquine-Resistant Plasmodium falciparum in the Central Highlands of Vietnam

The rise in Plasmodium falciparum resistance to dihydroartemisinin-piperaquine in Vietnam justifies the need to evaluate alternative artemisinin-based combination therapies. Between July 2018 and October 2019, a single-arm trial of pyronaridine-artesunate (Pyramax, PA) was conducted in Dak Nong province, Vietnam. PA (3-day course) was administered to adults and children infected with P. falciparum . PA was well tolerated by the participants. The proportion of patients with Day 42 PCR-corrected adequate clinical and parasitological response was 95.2% (95% confidence interval [CI], 82.3 to 98.8, n = 40/42) for treating falciparum malaria. The median parasite clearance half-life was 6.7 h (range, 2.6 to 11.9) and the median parasite clearance time was 72 h (range, 12 to 132) with 44.9% (22/49) of patients having positive blood films at 72 h. The two patients that recrudesced had comparable Day 7 blood pyronaridine concentrations (39.5 and 39.0 ng/ml) to the 40 patients who did not recrudesce (median 43.4 ng/ml, 95% CI, 35.1 to 54.9). Ring-stage and piperaquine survival assays revealed that of the 29 P. falciparum isolates collected from the patients before PA treatment, 22 (75.9%) had reduced susceptibility to artemisinins and 17 (58.6%) were resistant to piperaquine. Genotyping confirmed that 92.0% (46/50) of falciparum patients were infected with parasites bearing the Pfkelch13 C580Y mutation associated with artemisinin resistance. Of these, 56.0% (28/50) of the isolates also had multiple copies of the plasmepsin 2/3 genes responsible for piperaquine resistance. Overall, PA was effective in treating P. falciparum in the Central Highlands of Vietnam.

AN ANALYSIS OF TYPE I DILEMMA ZONE AT SIGNALISED INTERSECTIONS

Intersections, for vehicles coming from different directions, are conflict points in road networks. When a driver approaching a signalised intersection encounters the yellow light, he/she is in a dilemma either to safely stop or to pass through the intersection during clearance time. The decision to stop or to pass may change depending on some factors such as duration of yellow light, deceleration and acceleration rate, width of intersection, speed and length of vehicle, etc. This study aims to put forth the effects of some related factors affecting the length of the Type I dilemma zone. To perform this study, five factors including vehicle speed, maximum deceleration rate, perception-reaction time, clearance time, the total intersection width-vehicle length were considered and a total of 648 different traffic cases were investigated. The study results showed that the Type I dilemma zone length increased with the increase of speed, total intersection width-vehicle length and perception-reaction time, but decreased with the increase of clearance time and deceleration rate.