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Anam AM, Shareef A, Shumy F, Gerardus King MR. Preventing unrecognized deterioration & improving outcomes of critically ill patients using the National Early Warning Score 2 in a high dependency unit in Bangladesh: A quality improvement project. Trop Doct 2023; 53:419-427. [PMID: 37309167 DOI: 10.1177/00494755231178124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This Quality Improvement Project (QIP) aimed to assess the acceptability and utility of the National Early Warning Score 2 (NEWS2) in a Bangladeshi level-2 care setting. All nurses and physicians were trained on NEWS2 scores and a proper response before starting the QIP. Utilization of NEWS2 and patient outcome were documented and analyzed. Acceptability was acknowledged by increase in utilization, and utility by reduction in unrecognized deterioration of patients. The modified NEWS2 was well adopted and utilized by the nursing staff. There was a statistically significant reduction in unrecognized deterioration leading to cardiac arrest and the need for transfer to the Intensive Care Unit after implementation of NEWS2. With adequate training, motivation and appropriate modification, NEWS2 can become a well-accepted, widely adopted and realistic bedside monitoring tool in resource-limited settings like Bangladesh.
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Affiliation(s)
- Ahmad Mursel Anam
- Associate Consultant, Critical Care & Internal Medicine, Square Hospitals Ltd, Dhaka, Bangladesh
| | - Adnan Shareef
- Senior House Officer, HDU, Square Hospitals Ltd, Dhaka, Bangladesh
| | - Farzana Shumy
- Associate Consultant, Rheumatology & Internal Medicine, Square Hospitals Ltd, Dhaka, Bangladesh
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Hasan MJ, Sumi CD, Huq SMR, Anam AM, Rabbani R. Aerosolized Plus Intravenous Polymyxin B Versus Colistin in the Treatment of Pandrug-Resistant Klebsiella Pneumonia-mediated Ventilator-Associated Pneumonia: A Retrospective Cohort Study in Bangladesh. J Crit Care Med (Targu Mures) 2023; 9:106-115. [PMID: 37593252 PMCID: PMC10429625 DOI: 10.2478/jccm-2023-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/12/2023] [Indexed: 08/19/2023] Open
Abstract
Background Pandrug-resistant Klebsiella pneumoniae ventilator associated pneumonia (VAP) is associated with high rate of mortality in intensive care unit (ICU) and has been recognized as a difficult-to-treat infection worldwide. Polymyxin B or colistin-based combination therapies are frequently used worldwide though microbial eradication rate is not promising. Aim The aim of this study is to compare the clinical outcome of intravenous with aerosolized polymyxin B versus colistin in the treatment of pandrug-resistant K. pneumoniae VAP. Methods This retrospective cohort study was conducted on 222 mechanically ventilated patients admitted from May 11, 2019 to October 19, 2020. K. pneumoniae isolates were resistant to all available antibiotics, including polymyxins in culture sensitivity tests. As treatment, polymyxin B and colistin was administered in intravenous and aerosolized form concurrently twice daily in 106 patients and 116 patients in PMB and CLN group, respectively for 14 days. Survival rate, safety, and clinical outcomes were compared among the groups. The Cox proportional-hazard model was performed to calculate hazard ratio (HR) with 95% confidence intervals (CI). Results Patients in PMB group showed more microbial eradication than the patients CLN group [68.1% (n=116)/83% (n=106), respectively; P <0.05). The median day of intubation and ICU stay in PMB group was shorter than that in CLN group [10 (IQR: 9-12.25) vs. 14 (IQR: 11-19), P <0.05; 12 (IQR: 10-14) vs. 15 (IQR: 9-18.5), P=0.072, respectively] with reduced 60-day all-cause mortality rate [15% (n=106) vs. 21.55% (n=116)]. Polymyxin B improved survival compared to colistin (multivariate HR: 0.662; 95% CI=0.359-1.222, P=0.195). Conclusions Concurrent administration of intravenous and aerosolized polymyxin B in patients with pandrug-resistant K. pneumoniae-associated VAP revealed better microbial eradication, reduced the length of intubation and ICU stay, and improved survival rate compared to colistin.
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Affiliation(s)
| | | | | | | | - Raihan Rabbani
- Internal Medicine and ICU, Square Hospitals Ltd., Dhaka, Bangladesh
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Hasan MJ, Rabbani R, Anam AM, Huq SMR. Therapeutic safety and efficacy of triple-immunosuppressants versus dual-immunosuppressants in severe-to-critical COVID-19: a prospective cohort study in Bangladesh. Ann Med 2022; 54:723-732. [PMID: 35238257 PMCID: PMC8903771 DOI: 10.1080/07853890.2022.2039958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Hyperinflammation-induced respiratory failure is a leading cause of mortality in COVID-19 infection. Immunosuppressants such as, Baricitinib and interleukin inhibitors are the drug-of-choice to suppress cytokine storm in COVID-19. Here, we compared the therapeutic safety and efficacy of triple-immunosuppressants with dual-immunosuppressants in patients with severe-to-critical COVID-19. METHODS This study was conducted on 103 confirmed COVID-19 patients. Of 103 patients, 49 (N) and 54 (N) patients received dual-immunosuppressants (baricitinib plus two doses of secukinumab) and triple immunosuppressants (baricitinib plus single dose of tocilizumab and secukinumab) in group A and group B, respectively. Groups were compared in terms of clinical outcome, critical support-requirement, survival, re-hospitalisation, and adverse events (AEs). RESULTS Patients in group B achieved normal blood oxygen saturation level (SpO2) earlier than the patients of group A [4 day (IQR: 3-12) vs 5 day (IQR: 5-14), p < .05]. The requirement of intensive care unit (ICU) and mechanical ventilation (MV) support was less in group B than group A [16.7%/28.6%, 11.1%/18.4%, respectively p < .05]]. The incidence of COVID-19 acute respiratory distress syndrome and 60-day all cause mortality was reduced in group B compared to group A [0.43 (0.19-0.98), p < .05; 0.35 (0.08-1.44), p > .05]. The 60-day re-hospitalisation rate was two-fold high in group A than group B (p = .024). Immunosuppressant-associated adverse events and secondary bacterial/fungal infections were relative high in patients of group B. CONCLUSIONS Triple-immunosuppressants in severe-to-critical COVID-19 infection exhibited better clinical outcome; reduced ICU and MV requirement; shorter hospital stay with deceased 60-day all cause mortality and re-hospitalisation compared to dual-immunosuppressants.
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Affiliation(s)
- Md Jahidul Hasan
- Clinical Pharmacist (Critical Care and Infectious Diseases/Stewardship), Coordinator-Clinical Pharmacy, Department of Pharmacy, Square Hospitals Ltd, West Panthapath, Bangladesh
| | - Raihan Rabbani
- Internal Medicine and Intensive Care Unit, Department of Medical Services, Square Hospitals Ltd, West Panthapath, Bangladesh
| | - Ahmad Mursel Anam
- High Dependency Unit (HDU), Department of Medical Services, Square Hospitals Ltd, West Panthapath, Bangladesh
| | - Shihan Mahmud Redwanul Huq
- Internal Medicine and Intensive Care Unit, Department of Medical Services, Square Hospitals Ltd, West Panthapath, Bangladesh
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Hasan MJ, Rabbani R, Anam AM, Huq SMR, Polash MMI, Nessa SST, Bachar SC. Impact of high dose of baricitinib in severe COVID-19 pneumonia: a prospective cohort study in Bangladesh. BMC Infect Dis 2021; 21:427. [PMID: 33962573 PMCID: PMC8102838 DOI: 10.1186/s12879-021-06119-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/27/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Hyperinflammation in severe COVID-19 infection increases the risk of respiratory failure and one of the cogent reasons of mortality associated with COVID-19. Baricitinib, a janus kinases inhibitor, can potentially suppress inflammatory cascades in severe COVID-19 pneumonia. METHODS The objective of this study was to compare the clinical outcomes of high dose of baricitinib with its usual dose in patients with severe COVID-19 pneumonia. This prospective cohort study was conducted on 238 adult patients with severe COVID-19 pneumonia. Eight milligram and 4 mg of baricitinib was given orally to 122 patients in the high dose (HD) group and 116 patients the usual dose (UD) group, respectively daily for 14 days, and clinical outcomes were compared among the groups. RESULTS Blood oxygen saturation level was stabilized (≥94% on room air) earlier in the HD group compared to the UD group [5 (IQR: 4-5)/8 (IQR: 6-9), P < 0.05]. Patients in the HD group required intensive care unit (ICU) and intubation supports more in the UD group than that in patients of the HD group [17.2%/9%, P < 0.05; 11.2%/4.1%, P > 0.05; N = 116/122, respectively]. The 30-day mortality and 60-day rehospitalization rate were higher in the UD group than the HD group [6%/3.3%, P < 0.01; 11.9%/7.6%, P > 0.05; N = 116/122, respectively]. CONCLUSION The daily high dose of baricitinib in severe COVID-19 results in early stabilization of the respiratory functions, declined requirements of critical care supports, reduced rehospitalization with mortality rate compared to its daily usual dose.
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Affiliation(s)
- Md. Jahidul Hasan
- Clinical Pharmacist (Critical Care and Infectious Diseases/ Stewardship), Clinical Pharmacy Services, Department of Pharmacy, Square Hospitals Ltd., 18/F Bir Uttam Qazi Nuruzzaman Sarak, West Panthapath, Dhaka, 1205 Bangladesh
| | - Raihan Rabbani
- Internal Medicine and Intensive Care Unit, Department of Medical Services, Square Hospitals Ltd., 18/F Bir Uttam Qazi Nuruzzaman Sarak, West Panthapath, Dhaka, 1205 Bangladesh
| | - Ahmad Mursel Anam
- High Dependency Unit (HDU), Department of Medical Services, Square Hospitals Ltd., 18/F Bir Uttam Qazi Nuruzzaman Sarak, West Panthapath, Dhaka, 1205 Bangladesh
| | - Shihan Mahmud Redwanul Huq
- Internal Medicine and Intensive Care Unit, Department of Medical Services, Square Hospitals Ltd., 18/F Bir Uttam Qazi Nuruzzaman Sarak, West Panthapath, Dhaka, 1205 Bangladesh
| | - Mohammad Mufizul Islam Polash
- Intensive Care Unit, Department of Medical Services, Square Hospitals Ltd., 18/F Bir Uttam Qazi Nuruzzaman Sarak, West Panthapath, Dhaka, 1205 Bangladesh
| | - Shahzadi Sayeeda Tun Nessa
- Intensive Care Unit, Department of Medical Services, Square Hospitals Ltd., 18/F Bir Uttam Qazi Nuruzzaman Sarak, West Panthapath, Dhaka, 1205 Bangladesh
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Hasan MJ, Rabbani R, Anam AM, Huq SMR. Additional baricitinib loading dose improves clinical outcome in COVID-19. Open Med (Wars) 2020; 16:41-46. [PMID: 33364433 PMCID: PMC7729634 DOI: 10.1515/med-2021-0010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 01/15/2023] Open
Abstract
Pneumonia associated with coronavirus disease 2019 (COVID-19) has been accounted for high mortality rate in severe COVID-19 worldwide, and additional serious scarcity of standard and effective anti-inflammatory drug in COVID-19 pneumonia management is a big challenge. Baricitinib, a Janus kinase (JAK) inhibitor, is a promising drug in COVID-19 pneumonia. This study aims to compare the clinical outcome of moderate-to-severe COVID-19 pneumonia treated with baricitinib with or without a loading dose. This prospective case-control study enrolled 37 adult patients where 17 patients (control) received baricitinib at 4 mg oral daily dose and 20 patients (case) received an additional single 8 mg oral loading dose. The median day to gain blood oxygen saturation level ≥95% (in room air) and return in normal breathing function were lower in case group than the control group. The requirement of intensive care unit and mechanical ventilation support was higher in the control group than in the case group [29.4% (N = 17)/10% (N = 20), P < 0.05; 11.8% (N = 17)/5% (N = 20), P > 0.05), respectively]. Thus, an additional loading dose of baricitinib revealed better clinical outcome of patients with COVID-19 pneumonia.
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Affiliation(s)
- Md Jahidul Hasan
- Clinical Pharmacy Services, Department of Pharmacy, Square Hospitals Ltd, 18/F Bir Uttam Qazi Nuruzzaman Sarak, West Panthapath, Dhaka-1205, Bangladesh
| | - Raihan Rabbani
- Department of Medical Services, Internal Medicine and ICU, Square Hospitals Ltd, 18/F Bir Uttam Qazi Nuruzzaman Sarak, West Panthapath, Dhaka-1205, Bangladesh
| | - Ahmad Mursel Anam
- Department of Medical Services, High Dependency Unit (HDU), Square Hospitals Ltd, 18/F Bir Uttam Qazi Nuruzzaman Sarak, West Panthapath, Dhaka-1205, Bangladesh
| | - Shihan Mahmud Redwanul Huq
- Department of Medical Services, Internal Medicine and ICU, Square Hospitals Ltd, 18/F Bir Uttam Qazi Nuruzzaman Sarak, West Panthapath, Dhaka-1205, Bangladesh
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Huq SMR, Anam AM, Joarder N, Islam MM, Rabbani R, Shaikh AK. A young adult with
post-traumatic breathlessness, unconsciousness and rash. Breathe (Sheff) 2019; 15:e126-e130. [PMID: 31777576 PMCID: PMC6876139 DOI: 10.1183/20734735.0212-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A 23-year-old Bangladeshi male was referred to our hospital for gradual worsening of breathlessness over 3 h, developed following a road-accident about 14 h previously. He had a close fracture of mid-shaft of his right tibia, which was immobilised with back slab at the previous healthcare facility. During presentation at the emergency department, he was conscious and oriented (Glasgow coma scale 15/15), tachycardic (heart rate 132 per min), blood pressure 100/70 mmHg, tachypnoeic (respiratory rate 34 per min) with oxygen saturation 89% on room air, and afebrile. Chest examination revealed restricted chest movement, hyper-resonant percussion notes and reduced breath sound on the left, and diffuse crackles on both sides. Can you diagnose this young adult with post-traumatic breathlessness, unconsciousness and rash?http://bit.ly/2LlpkiV
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Affiliation(s)
| | | | - Nayeema Joarder
- Intensive Care Unit, Square Hospitals Ltd., Dhaka, Bangladesh
| | | | - Raihan Rabbani
- Critical Care and Internal Medicine, Square Hospitals Ltd., Dhaka, Bangladesh
| | - Abdul Kader Shaikh
- Dept of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.,Dept of Neurology, Square Hospitals Ltd., Dhaka, Bangladesh
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Affiliation(s)
- Ahmad Mursel Anam
- Intensive Care Unit, Square Hospitals Ltd, 18/F, Bir Uttam Qazi Nuruzzaman sarak, Dhaka 1205, Bangladesh,
| | - Jamia Ahmad
- Intensive Care Unit, Square Hospitals Ltd, Dhaka, Bangladesh
| | | | - Raihan Rabbani
- Intensive Care Unit, Square Hospitals Ltd, Dhaka, Bangladesh
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Abstract
An elderly man presented with the history of diphenhydramine hydrochloride overdose as a suicidal attempt. At presentation, he was in an acute confusional state with several anticholinergic features and had to be managed in intensive care unit. As an antidote for diphenhydramine hydrochloride, donepezil was used instead of physostigmine due to the unavailability of physostigmine in Bangladesh. The patient improved within the next 24 hours; his level of consciousness improved and the anticholinergic features regressed.
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Affiliation(s)
- Jamia Ahmad
- Intensive Care Unit, Square Hospitals Ltd., Dhaka, Bangladesh
| | - Md Jahidul Hasan
- Department of Pharmacy, Square Hospitals Ltd., Dhaka, Bangladesh
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Hasan MJ, Ahmad J, Anam AM, Rabbani R. N-acetylcysteine in the Effective Management of TEN-associated Severe Skin Lesions. app 2019. [DOI: 10.13189/app.2019.070101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Shumy F, Anam AM, Chowdhury MAJ. Spontaneous bilateral perirenal and splenic haematoma in childhood onset polyarteritis nodosa. BMJ Case Rep 2018; 2018:bcr-2018-225762. [PMID: 29950374 DOI: 10.1136/bcr-2018-225762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Spontaneous bilateral perirenal haematoma, as well as splenic haematoma, are rare occasions in polyarteritis nodosa (PAN). We report a case of a young man, who suffered from various typical and atypical manifestations of PAN since childhood. The diagnosis was delayed due to symptoms mimicking with other clinical conditions. Finally, the diagnosis was confirmed when presented with perirenal and splenic haematoma and was managed successfully.
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Affiliation(s)
- Farzana Shumy
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Abstract
We report a case of spontaneous calf muscle haematoma, formed during the recovery phase of dengue haemorrhagic fever, which, to the best of our knowledge, has never been encountered before. A 45-year-old man presented with features of severe dengue and got admitted to our intensive care unit. He was treated with intravenous fluid therapy and supportive measures, and gradually improved, initially. However, during the recovery phase, he suddenly developed painful left calf, which was found tender, hot and swollen on physical examination. Colour Doppler ultrasound revealed left calf haematoma. As the patient rapidly developed local compartmental syndrome, surgical evacuation of the haematoma followed by urgent fasciotomy was performed. He recovered without further complication and was discharged home. At follow-up after 2 months, he remained well.
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Affiliation(s)
| | - Raihan Rabbani
- Intensive Care Unit, Square Hospitals Ltd, Dhaka, Bangladesh
| | - Farzana Shumy
- Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Shumy F, Anam AM, Chowdhury MAJ. Cutaneous leucocytoclastic vasculitis in visceral leishmaniasis. Trop Doct 2018; 48:38-40. [DOI: 10.1177/0049475517718971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Farzana Shumy
- Medical Officer, Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Ahmad Mursel Anam
- Specialist, Intensive Care Unit, Square Hospitals Ltd., Dhaka, Bangladesh
| | - MA Jalil Chowdhury
- Professor and Chairman, Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Abstract
We report a case of expanded dengue syndrome, where three uncommon presentations occurred concomitantly. A patient with dengue haemorrhagic fever presented initially with acute acalculous cholecystitis along with acute pancreatitis, but later on, during resolution of pancreatitis and cholecystitis, developed pancytopenia, most likely due to haemophagocytic syndrome. Such presentations, besides being rare themselves, have not been reported to occur concomitantly, in the same patient, during the same disease process.
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Affiliation(s)
| | - Raihan Rabbani
- 2 Consultant, ICU, Square Hospitals Ltd., Dhaka, Bangladesh
| | - Farzana Shumy
- 3 Medical Officer, Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Abstract
Acute arsenicosis, although having a ‘historical’ background, is not common in our times. This report describes a case of acute arsenic poisoning, missed initially due to its gastroenteritis-like presentation, but suspected and confirmed much later, when the patient sought medical help for delayed complications after about 2 months.
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Affiliation(s)
- Farzana Shumy
- Medical Officer, Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Ahmad Mursel Anam
- Chief Resident, Intensive Care Unit, Square Hospitals Ltd., Dhaka, Bangladesh
| | - AKM Kamruzzaman
- Postgraduate student, Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Robed Amin
- Associate Professor, Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - MA Jalil Chowdhury
- Professor and Chairman, Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Abstract
We report a case of expanded dengue syndrome, where two different presentations occurred subsequently. A patient of dengue haemorrhagic fever initially was admitted with acute pancreatitis, complicated with left pancreatic effusion, but later on, during resolution of pancreatitis and effusion, developed spontaneous right haemothorax. Such presentations, besides being rare themselves, have not been reported to occur subsequently, in the same patient, during the same disease process.
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Affiliation(s)
- Ahmad Mursel Anam
- Chief Resident, Intensive Care Unit, Square Hospitals Ltd., Dhaka, Bangladesh
| | - Raihan Rabbani
- Consultant, Intensive Care Unit, Square Hospitals Ltd., Dhaka, Bangladesh
| | - Farzana Shumy
- Medical Officer, Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Shumy F, Faiz MA, Anam AM. Predilection of zonal involvement and pattern of opacities in chest x-ray in post primary pulmonary tuberculosis. Mymensingh Med J 2013; 22:721-726. [PMID: 24292303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A cross sectional analysis of chest radiograph was performed in 100 patients with tuberculosis to observe the recent trends of radiographic presentation. The study was done from April to December, 2009, in Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh. The chest x-ray findings were analyzed and zonal involvement and pattern of opacities were categorized and compared. Majority of patients (45%) showed involvement of the upper zone. Dominating lesion was consolidation (25%). Most of the patients were between 15-40 years. Forty-four percent patients were sputum positive for Acid Fast Bacilli and cavitation was the dominant lesion among them. Chest x-ray of patients with post primary tuberculosis shows involvement predominantly in the upper zone of lung. The most common opacity was consolidation. This correlates with different studies done over different population.
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Affiliation(s)
- F Shumy
- Dr Farzana Shumy, Post Graduate Trainee, Department of Medicine, Sir Salimulla Medical College & Mitford Hospital, Dhaka, Bangladesh
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Abstract
Dengue is a mosquito-borne systemic viral infection with variety of clinical presentation, ranging from mild febrile illness to severe and fatal disease. A patient presented with history of fever and abdominal pain, and later developed shock. From clinical and epidemiological features, he was diagnosed as a patient of severe dengue, later confirmed by laboratory investigations. In dengue, shock can result from plasma leakage, and abdominal pain may be a feature of acalculous cholecystitis or pancreatitis, recognised presentations of dengue and usually managed conservatively. But high index of suspicion persuaded abdominal imaging, revealing a potentially fatal complication of dengue- spontaneous splenic rupture. Aggressive resuscitation and early surgery saved the patient. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14373 Bangladesh Crit Care J March 2013; 1: 59-62
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Shumy F, Anam AM, Chowdhury MAJ, Azad MAK, Nahar S. Multifocal Extensive Spinal Tuberculosis with Retropharyngeal Abscess. Bangabandhu Sheikh Mujib Medical Univ J 2011. [DOI: 10.3329/bsmmuj.v4i2.8646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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