Bailey and Love's Short Practice of Surgery

Timing of antibiotic administration and outcomes for medicare patients hospitalized with community-acquired pneumonia

Organophosphate and carbamate (OPC) poisoning is a major global health hazard requiring immediate medical intervention. Atropine (ATR) is an essential antidote in organophosphate and carbamate poisoning, with the inclusion of cholinesterase reactivators and other anticholinergics, namely pralidoxime (PAM) and glycopyrrolate (GPR). This study aimed to compare the efficacy of various treatment regimens and identify the factors affecting mortality. The data of patients presented at the emergency unit with the consumption of OPC compounds between the years 2013 and 2017 were retrospectively reviewed. The study population was then categorized into four treatment patterns (1) ATR alone, (2) ATR and PAM, (3) ATR and GPR, (4) ATR, PAM and GPR. The outcome of the patients was assessed in terms of survival, intubation, ICU days, and days of ventilation and hospitalization. Univariate and multivariate analyses were performed to investigate the risk factors associated with mortality and odds ratio (OR). A total of 441 patients were included in the study, of which 69.16% were males, and 375 patients survived. Consumption of poison with a suicidal intention was reported in 98.19% of the patients, and the treatment with ATR and PAM (42.86%) was observed to have lower days of ventilation in comparison to the treatment with ATR and GPR (p = 0.003). Patients requiring intubation were also lowest in the group treated with ATR and PAM (27.51%). The age group of > 50 years (OR 4.275 [CI 2.179–8.387]), male gender (OR 2.608 [CI 1.258–5.406]), and the treatment pattern with ATR, PAM and GPR (OR 2.233 [CI 1.002–4.040]) were independently associated with mortality. In summary, male gender, elderly population, and treatment patterns followed adversely affected the outcome in patients with OPC poisoning.

Factors associated with outcomes in organophosphate and carbamate poisoning: a retrospective study

Laurence-Moon-Bardet-Biedl syndrome (LMBBS), a rare autosomal recessive defect, mostly occurs in children born from consanguineous marriages. The major features of this syndrome are cone-rod dystrophy, polydactyly, obesity, learning disabilities, hypogonadism in males, renal anomalies, nystagmus, speech disorders, developmental delay, polyuria/polydipsia, ataxia, and poor coordination/clumsiness. In this report, we present a case of a 19-year-old man with pain and swelling of the left ankle and knee joints because of which he could not walk, with an onset of loose stools since a week. He presented with multiple non-itchy hyperpigmented macules on his face and back, polydactyly in his left foot, central obesity, proteinuria, macrocytic anemia, low intelligence quotient, reduced power in the left lower limb, reduced plantar reflexes, nystagmus, pigmented black lesions in the temporal retina on fundoscopy, a micropenis, absent pubic and axillary hair, and a small scrotum containing testes. The patient was diagnosed with LMBBS.

Laurence-Moon-Bardet-Biedl Syndrome: A Case Report.

UV light exposure affecting in reducing collagen and skin elastin collagen (photoaging). This research aimed at obtaining a formula of bay (Syzygium polyanthum [Wight.] Walp.) leaf and tomato (Lycopersicum pyriform) fruit extract for soft drink package as an anti-aging potential in term of avoiding aging process caused by UV-B light. The measured indicators were superoxide dismutase (SOD) activity, Copper (Cu) content, Zinc-SOD (Zn-SOD), and malondialdehyde (MDA) level. This experimental research employed a post-test only control group design by giving various extracts of bay leaves and tomato fruits to mice. The treatments given were: P0, P1, P2, P3, and P4. The data obtained were analyzed using ANOVA, which then continued to LSD test. The results showed that the treatment of 8 g/kg BW of tomato fruit extract and 3 g/kg bay leaves extract has been proven to be effective in stabilizing MDA level, SOD activity and Cu level, as well as preventing the decreasing Zn-SOD as the effect of UV-B radiation in mice skin.

Bay leaves and tomato extract: The formulation of anti-aging drink

Laurence Moon Bardet Biedle syndrome is a rare, autosomal recessive genetic disorder involving multiple systems and has wide spectrum of clinical features. Characteristic features of this disorder are retinitis pigmentosa, polydactyly, truncal obesity and learning difficulties. It may also be associated with hypogonadism in male and complex genitourinary abnormalities in female. We present a case of 33 years male patient having obesity, decreased vision, polydactyly, hypogonadism and retinitis pigmentosa. These clinical features are consistent with Laurence Moon Bardet Biedle syndrome. Medicine Today 2018 Vol.30(1): 41-43

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Laurence Moon Bardet Biedle Syndrome

Background: Detection of mass in the breastis very essential for the early treatment. Objective: The purpose of the present study was to validate the Doppler sonography to detect the pathological lesions of breast. Methodology: This cross sectional study was carried out in the Department of Radiology and Imaging in collaboration with the Department of Surgery and Department of Pathology at Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from July 2008 to June 2009 for a period of one (01) year. Clinically suspected women with breast mass who were attended in the OPD or inpatient department were selected purposively as study population. All the patients were examined by 2-D Real-Time B-Mode Ultrasonography by using high frequency (7.5 MHz) linear transducer. Blood flow was studied using Duplex sonography in which Gray scale 2D sonography was combined with Pulsed Doppler. Test of validity was done for color Doppler Sonographic findings in evaluation of benign and malignant breast lesion. Result: A total number of 50 cases were recruited for this study. Out of 50 cases,25 cases true positive, 1 false negative, 2 false positive, 22 true negative confirmed by histopathology. Here sensitivity and specificity of color Doppler ultrasonography are 92.59% and 86.95% respectively. Here accuracy of color Doppler study is 90.0% and the positive predictive value was 89.28% and negative predictive value was 90.9%. Conclusion: Color Doppler Ultrasonography is a useful imaging method in the differentiation between benign and malignant breast masses. Journal of National Institute of Neurosciences Bangladesh, 2017;3(1): 10-13

Validity of Gray Scale Sonography along with Color Doppler Spectral Analysis for the detection of Malignant Breast Tumour

Background: Organophosphorus compound (OPC) poisoning is common in Bangladesh and management facility is not adequate in most hospitals. Both inj. Atropine and inj. Pralidoxime is used as antidote for the management of OPC poisoning, although there is controversy regarding benefit of inj. Pralidoxime. Objective: This randomised clinical trial was conducted to compare the outcome of OPC poisoning patients treated by inj. Atropine along with supportive measures and by inj. Atropine plus inj. Pralidoxime along with supportive measures . This study also evaluated the clinical profile of OPC poisoning patients. Methods: A total number of 109 patients, admitted in medicine ward in Khulna medical college hospital during one year period were included in this randomised clinical trial. The patients were divided into two groups according to alternate day of admission in the medicine wards. Forty nine patients of group A was treated by inj. atropine only along with other supportive measures required and group B of 60 patients was treated by inj. atropine plus inj. pralidoxime along with supportive measures. Results: 49 patients of group A was treated with atropine alone and 60 patients in group B was treated with atropine plus pralidoxime. Death rate was 14.28% in atropine treated group and 16.66% in atropine plus pralidoxime treated group (p=0.733). The difference in death rate is not statistically significant. Four (8.18%) patients from atropine treated group and 4 (6.67%) patients from pralidoxime intervention group developed respiratory failure and ventilatory support was given in ICU. These 8 patients recovered. But this difference in development of respiratory failure is not statistically significant (p=0.766). The difference of death rate between male and female (12.5% Vs 18.87%) is not also significant (p=0.360). Conclusion: This study reveals that pralidoxime provides no better outcome in the management of OPC poisoning patients. Bang Med J (Khulna) 2017; 50 : 3-7

Outcome of treatment of OPC poisoning patients with atropine or atropine plus pralidoxime

Background: Community acquired pneumonia (CAP) is a leading cause of morbidity and mortality in Bangladesh. There is difficulty in identification of the causative organism due to lack of facility of sputum culture and sensitivity test in many hospitals of Bangladesh. So targeted anti microbial therapy is not possible and empirical antibiotic prescription is done. The choice of empirical selection of antibiotic should be the best effective drug for the treatment of CAP. Objective: To assess the efficacy of selected empirical antibiotic selection for the treatment of CAP. Methods: This prospective observational study involves 82 patients with CAP admitted in medicine ward of Khulna medical college hospital, Khulna, Bangladesh. Patients were selected by inclusion and exclusion criteria. Diagnosis of CAP was confirmed by chest x-ray. Empirical selection of antibiotic was based on clinical experience. Most of the patients were treated with combined antibiotic except a few with monotherapy. Evaluation of the empirical choice of ant biotic was done by the outcome. Data of different parameter were recorded during study in preformed proforma. Statistical analysis was done by using SPSS. Result: Out of 82 patients 62 (76%) were male and 20 (24%) were female. Mean age was 54.4 (± 9.6) years. Duration of antibiotic treatment was 7 days. No drug related adverse effect was observed. One patient developed paraneumonic effusion and none of the patient developed lung parenchymal damage or lung abscess. All the patient recovered completely. Conclusion: CAP is treated in many hospitals of Bangladesh by selecting the antibiotic empirically. Improvement of hospital laboratories to perform sputum for culture and sensitivity test is necessary for selecting an effective anti biotic. Key wards: Community acquired pneumonia, Empirical, Antibiotic.

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Efficacy of empirical antibiotic prescription for the treatment of community acquired pneumonia

Background: One of the common medical emergencies is Snake-bite. Many patients die every year due to snakebite. However, the demographic feature, clinical manifestations, mortality and morbidity from snake-bite in our country has not been well studied. This study analyses demographic feature, clinical manifestations and outcomes of the snake bite poisoning in patients admitted to a medical college hospital. Aims & Objectives: To determine the demographic features, clinical manifestations and outcomes of the snake bite poisoning. Materials and Methods: This is an observational study done in the department of Medicine,Khulna Medical College Hospital from 1st July 2017 to 30th June 2018. Patients aged 13 years and above admitted with the suspicion of snake bite during the period were selected. Results: Out of 114 admitted snakebite patient most of the patients 50 (43.85%) are of younger age groups (13-40 years). Most bites occurred in rural area 108 (94.73%) and 74 (64.91%%) occurred between the months of July to September. Most cases 70 (61.40%) are non-venomous snake bites; krait was the main culprit for all venomous 44 (38.59%) cases showing neurotoxic features. Foot was the most common (42.10%) site of bite. ptosis (38.59%) and broken neck sign (17.54%) were the two most common clinical features. All venomous cases received 10-20 vials of anti-venom. 31.81% (14) of venomous patients developed respiratory failure requiring mechanical ventilation; of them 6 (13%) died. Conclusions: Snakebite is one of common emergency that endangers life in the study area. Treatment by Ohzas is very common and this causes Delay in hospitalization resulting in respiratory failure and increases mortality.

SM Kamal

Papers

Laurence Moon Bardet Biedle Syndrome

Validity of Gray Scale Sonography along with Color Doppler Spectral Analysis for the detection of Malignant Breast Tumour

Outcome of treatment of OPC poisoning patients with atropine or atropine plus pralidoxime

Efficacy of empirical antibiotic prescription for the treatment of community acquired pneumonia

Demographic & Clinical characteristics with outcomes of snake bite in a tertiary hospital