BackgroundPesticide self-poisoning is a major problem in Bangladesh. Over the past 20-years, the Bangladesh government has introduced pesticide legislation and banned highly hazardous pesticides (HHPs) from agricultural use. We aimed to assess the impacts of pesticide bans on suicide and on agricultural production.MethodsWe obtained data on unnatural deaths from the Statistics Division of Bangladesh Police, and used negative binomial regression to quantify changes in pesticide suicides and unnatural deaths following removal of WHO Class I toxicity HHPs from agriculture in 2000. We assessed contemporaneous trends in other risk factors, pesticide usage and agricultural production in Bangladesh from 1996 to 2014.ResultsMortality in hospital from pesticide poisoning fell after the 2000 ban: 15.1% vs 9.5%, relative reduction 37.1% [95% confidence interval (CI) 35.4 to 38.8%]. The pesticide poisoning suicide rate fell from 6.3/100 000 in 1996 to 2.2/100 000 in 2014, a 65.1% (52.0 to 76.7%) decline. There was a modest simultaneous increase in hanging suicides [20.0% (8.4 to 36.9%) increase] but the overall incidence of unnatural deaths fell from 14.0/100 000 to 10.5/100 000 [25.0% (18.1 to 33.0%) decline]. There were 35 071 (95% CI 25 959 to 45 666) fewer pesticide suicides in 2001 to 2014 compared with the number predicted based on trends between 1996 to 2000. This reduction in rate of pesticide suicides occurred despite increased pesticide use and no change in admissions for pesticide poisoning, with no apparent influence on agricultural output.ConclusionsStrengthening pesticide regulation and banning WHO Class I toxicity HHPs in Bangladesh were associated with major reductions in deaths and hospital mortality, without any apparent effect on agricultural output. Our data indicate that removing HHPs from agriculture can rapidly reduce suicides without imposing substantial agricultural costs.

BackgroundSince Bangladesh government issued a ban on the use of highly toxic WHO Class I pesticides, annual consumption of herbicides like Paraquat have been sharply increasing in the markets. Paraquat poisoning is an emerging public health threat and its high mortality rate is responsible for a significant number of deaths. Diagnostic limitations and unavailable sample at presentation have resulted in under-reporting and lack of awareness among the treating physicians, making Paraquat poisoning one of the most neglected toxicological emergencies. Herein, we present a case of Paraquat induced multi-organ failure and emphasis on pitfalls in the management.Case presentationAn 18-years-old healthy male was admitted in Sylhet M.A.G Osmani Medical College Hospital with history of attempted suicide by Paraquat ingestion. On admission, he had high serum creatinine but otherwise asymptomatic. He was discharged on day 10 when his renal functions returned to normal. But On day 15, he started having respiratory symptoms—unresponsive to any of the local treatments he received, and by day 30, he developed overt lung fibrosis. We present sequential blood picture, radiographs and CT scans demonstrating Paraquat induced kidney and lung injury over the course of 30 days.ConclusionParaquat poisoning can lead to death and fatal long-term consequences. All cases of Paraquat poisoning, regardless of symptoms, must be hospitalized and observed for early detection of complications. Distribution of Paraquat should be restricted and/or banned as 38 other countries have done so, which we believe will greatly reduce poisoning related mortality.Electronic supplementary materialThe online version of this article (10.1186/s13104-018-3425-3) contains supplementary material, which is available to authorized users.

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Sepsis is a systemic, deleterious host response to infection leading to acute organ dysfunction secondary to documented or suspected infection and septic shock i.e. sepsis plus hypotension not reversed with fluid resuscitation. Severe sepsis is a major healthcare problem with an extremely high mortality rate of 30-60% and it is one of the most common reasons for critically ill patients to be admitted to an intensive care unit (ICU). Excessive inflammation and coagulation and suppression of fibrinolysis are the hallmarks of Sepsis. Our medical concern is to manage sepsis and to prevent multi organ failure (MOF). Making an early, accurate diagnosis of septic shock is the key to increasing survival rates. With no specific, effective anti-sepsis therapies available, management focuses on haemodynamic stabilization and rapid resuscitation, early source control, adequate and appropriate antibiotics, organ support and modulation of the septic responses are the cornerstones of treatment.

Osteoporosis is characterized by low bone density, micro-architectural deterioration of the bone tissue, enhanced bone fragility and increasing susceptibility to fracture. Osteoporosis is an important public health problem leading to an increased risk of developing spontaneous and traumatic fractures. It is a silent disease until it is complicated by fractures that can occur following minimal trauma. These fractures are common and place an enormous medical and personal burden on individuals during aging and a major economic toll on the nation. To reduce the burden high-risk patients must be identified, evaluated for factors contributing to skeletal fragility, and should be treated to reduce fracture risk. Osteoporosis is a preventable disease and can be diagnosed and treated before any fracture occurs. Importantly, even after the first fracture has occurred, there are effective treatments to decrease the risk of further fractures. Both Pharmacologic and non- pharmacological interventions can reduce the risk for fracture in appropriately selected patients, with a generally favorable safety profile.Bangladesh Med J. 2016 May; 45 (2): 101-109