Brain abscess in a 12-year-old child with congenital heart disease: lessons learnt

Brain abscess is a rare and often life-threatening sequelae, observed in 5-20% of the patients with cyanotic congenital heart diseases (CHD). Cyanotic heart diseases involve a right-to-left shunt by-passing the pulmonary vascular bed, culminating in tissue hypoxia. We present a case of an uncorrected atrioventricular canal defect (AVCD) with a double outlet right ventricle (DORV) complicated by a brain abscess in a 12-year-old girl. This patient was a known case of CHD diagnosed at 2 years of age and presented to the neurology out-patient department with a holocranial headache, vomiting, and low-grade fever for 5 days. General examination was suggestive of cyanosis and low-set ears. Systemic examination revealed a pansystolic murmur with bilateral extensor plantar reflexes. MRI brain with contrast revealed an abscess in the right temporoparietal lobe with perilesional edema. The patient was managed conservatively. Nine days post-discharge, the patient presented with generalized tonic-clonic seizures and was readmitted and managed accordingly. Subsequently, she was referred to the cardiothoracic surgery department for correction of the CHD. However, the family gave negative consent for the same. The relatives of the case described here were counseled to get a surgical correction done for the cardiac defect at the time of diagnosis but with no success. The aim of publishing this case is to emphasize the need for timely diagnosis and correction of such anomalies to curb serious complications causing profound morbidity and mortality.

Congenital multiseptate gall bladder in a child: a rare case report

Congenital multiseptate gallbladder (CMGB), is a rare congenital anomaly of gall bladder and it may be associated with other abnormalities. The gallbladder has one or many septa that divides the cavity into multiple distinct sections. It is considered as a pseudo-duplication of the gallbladder. Septate gall-bladder has not been a well-documented entity as most of the patients are asymptomatic, and this is usually an incidental finding which is discovered accidentally during the evaluation of abdominal pain. Some patients may present to the clinician with the complaints of pain in the right hypochondrium and epigastrium or colicky abdominal pain. Rarely, there may be stone formation due to septations, which may lead to recurrent abdominal pain. The most accurate way to diagnose septate gall-bladder is to combine ultrasonography and magnetic resonance cholangiography (MRCP). Here we present a four-year-old female child with a multiseptate gall bladder who underwent laparoscopic cholecystectomy, and her abdominal pain resolved entirely.

Empyema associated with Lemierre syndrome: case report and literature review

Postanginal septicemia, also called Lemierre syndrome, is a metastatic infection that can have multiple complications, including empyema. Therefore, the natural history of the disease begins with an infection of the oropharynx by microbiota from the digestive system, which causes a thrombophlebitis of the jugular vein with septic infiltrations, including into the lungs causing pneumonia, which in turn can generate parapneumonic effusions and/or empyemas. Furthermore, it is a syndrome that was thought to have been forgotten by the era of antibiotics, but with resistance to these antibiotics it has begun to re-emerge. Next, we will talk about a case of a 41-year-old man with no significant pathological history, who entered secondary to a peritonsillar abscess which turned into Lemierre syndrome with a treatment based on broad-spectrum antibiotics and then performed of lung decortication by thoracotomy. Empyema as a complication of Lemierre syndrome is rare and even more so in this post-antibiotic era, so health personnel should have a high clinical suspicion since adequate and timely treatment will help reduce the complications of this disease, as well as like his mortality.

Assessment of serum IgE level in patients with transfusion related allergic reaction receiving fresh frozen plasma

Background: Blood transfusion is a routine lifesaving medical intervention which is generally regarded as safe when done properly. However, at the same time it also bears considerable risk. The aim of the study was to assess the serum IgE levels in patients experiencing transfusion-related allergic reactions after receiving fresh frozen plasma. Methods: This cross-sectional observational study was conducted at the Department of Transfusion Medicine, BSMMU, from March 2019 to August 2021, focusing on patients aged 5 to 60 years receiving fresh frozen plasma. Patients were included after obtaining informed consent from themselves or their legal guardians in the case of minors, according to the eligibility criteria. Data were analyzed using SPSS version 26, with statistical significance set at p<0.05, employing Chi-square tests and Pearson抯 correlation coefficient for variable comparisons. Results: Raised IgE level was significantly related with transfusion related allergic reaction after receiving fresh frozen plasma (p<0.05). The mean IgE was 521.4�4.6 in patients with reaction and 67.8�.2 in patients without reaction. Significant positive correlation was observed in serum IgE level with age in years. Conclusions: Patients with transfusion related allergic reaction receiving fresh frozen plasma had higher mean IgE levels as compared to those without reaction.

Comparison of psychosocial strengths and difficulties in children born through assisted reproductive technology versus naturally conceived children

Background: Assisted reproductive technology (ART) is a set of medical interventions used to facilitate the conception process in couples suffering from fertility issues. ART encompasses several techniques, including ovulation induction (OI), artificial insemination, testicular sperm extraction (TESE), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI). This current study aimed to analyze the correlation between psychological strength and difficulties among children born by ART and normally conceived (NC) children. Methods: The study was conducted in a longitudinal retrospective fashion, in Combined Military Hospital, Dhaka, Bangladesh, from December 2022 to June 2023. A total of 47 participants from the ART group and 50 participants from the NC group were selected as study subjects by purposive sampling technique. Data were gathered using a pre-designed questionnaire and analyzed using the statistical package for the social sciences (SPSS) version 23.0 computer program. Results: The age range of the study participants was between 2 to 4 years old. A majority of the participants were female (53.2%), hailed from middle-class families (59.6%), lived in urban settings (42.6%), and identified as Muslim (72.3%). In terms of illnesses, a small proportion experienced physical ailments (6.4%) and psychiatric conditions (10.6%). Conclusions: Despite persistent worries regarding the potential adverse developmental effects on children conceived by ART, research findings suggest that such children do not exhibit noteworthy physical, psychological, or developmental challenges when compared to those conceived naturally.

Association of plasma fibrinogen level with the severity of obstructive sleep apnoea patients in a tertiary care hospital

Background: Obstructive sleep apnoea syndrome (OSAS) is a common sleep-related breathing disorder of multi-risk factorial pathogenesis and is characterized by recurrent, partial or complete upper airway obstruction resulting in intermittent hypoxia during sleep. It has been implicated in both cardiovascular and cerebrovascular diseases. Objective of the study was to determine the association of Plasma Fibrinogen levels with the severity of OSA patients in a tertiary care hospital. Methods: This cross-sectional observational study with group comparison was conducted among all the patients attending in the Department of Respiratory Medicine, BSMMU with suspicion of OSA within one year after the clearance of institutional review board (IRB) using STOP-BANG questionnaire and Epworth sleepiness scale (ESS) and confirmed by polysomnography. Plasma fibrinogen was measured in all OSA and non-OSA patients. Data were analyzed with the help of statistical package for the social sciences (SPSS) version 26. Results: Sociodemographic analysis found no significant differences in age, gender, area, occupation, or smoking between OSA and non-OSA groups (p>0.05). However, witnessed apnoea (p=0.002), breathlessness (p=0.005), higher ESS (p<0.001), and STOP-Bang scores (p<0.001) were associated with OSA. Plasma fibrinogen levels were significantly higher in OSA (319.2±63.7 mg/dl versus 242.5±20.33 mg/dl, p<0.001), positively correlating with AHI (r=+0.876, p=0.001). Positive correlations were also found between fibrinogen levels and daytime sleepiness (r= +0.393, p=0.002), waist circumference (r =+0.346, p=0.007), and BMI (r =+0.297, p=0.021) in OSA patients. Conclusions: In conclusion, this study establishes a notable connection between plasma fibrinogen levels and the severity of OSA. Elevated fibrinogen levels correlate with increased OSA severity, indicating a link between OSA, inflammation and coagulation.

Association of radiological type of dural tail sign in contrast MRI with histopathological grading of intracranial meningiomas

Background: In neurosurgical practice meningiomas are one of the commonest intracranial tumors to seek surgical intervention which is classified into 3 histological grades and 15 subtypes according to the 2016 WHO classification of tumors of the CNS. The aim of this study was to evaluate the association between radiological type of dural tail sign in contrast MRI with histopathological grading of intracranial meningiomas. Methods: This was a cross sectional interventional study carried out in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Dhaka Medical College Hospital and National Institute of Neuroscience Hospital including 35 patients of intracranial meningiomas who fulfilled the selection criteria were enrolled in this study. Results: This study included 35 cases of intracranial meningiomas. There were 22 individuals (62.9%) in the 28-47 age group. The mean±standard deviation (SD) age of the participants was 45.97±9.56 years. There were 9 male participants (25.7%) and 26 female participants (74.3%) with ratio 1:3. We see that parasagittal location (50%) and sphenoid wing (33.3%) were more prevalent in grade II. We found significant distribution of the types of DTS among the histological grades of meningioma. The nodular cases (6,100%) were all grade II type. Mixed type was the most prevalent type among grade I. Conclusions: There is association of radiological type of dural tail sign in contrast MRI with histopathological grading of intracranial meningiomas and may be used as a good tools for forecasting tumor type and prognosis.

Association of serum alpha-1 antitrypsin level with the severity of COPD

Background: Alpha-1 antitrypsin deficiency (AATD) is a hereditary disorder linked to early onset COPD, notably the emphysema variety, but often goes undetected. Low serum AAT levels may impact lung function and correlate with COPD severity. The aim of the study was to detect possible associations of serum AAT level with the severity of COPD patients on the basis of post bronchodilator FEV1 in Bangabandhu Sheikh Mujib Medical University (BSMMU). Methods: A cross-sectional study was conducted at the Department of Respiratory Medicine, BSMMU, Dhaka, from October 2022 to September 2023. Adult patients (?18 years) of both genders diagnosed with COPD based on spirometry were included. COPD was defined per GOLD guidelines, with a post-bronchodilator FEV1/FVC ratio <70%. Severity was categorized based on post-bronchodilator FEV1% predicted. Association between serum AAT level and COPD severity was analyzed using SPSS version 26, with significance set at p <0.05. Results: The study involved 80 COPD patients, with 1.25% showing low serum AAT levels and 98.75% normal. No significant differences in age, sex, or smoking status were observed among severity groups. Mean serum AAT levels varied across severity groups but were not statistically significant (p=0.377). Smoking was prevalent (66.3%), with common comorbidities like hypertension (26.3%), IHD (16.3%), and diabetes mellitus (15.0%). Shortness of breath (95.0%) and cough (92.5%) were common symptoms, with most patients having moderate disease severity (42.5%). Conclusions: The study indicates a weak association between serum AAT levels and COPD severity, with only 1.25% of 80 patients exhibiting low AAT levels.

Observation of cardiac profile among the adult population of Sreemangal

Background: Cardiovascular diseases are a leading cause of morbidity and mortality worldwide. The prevalence and risk factors of CVDs vary across different populations and regions. This study aimed to observe the cardiac profile among the adult population of Sreemangal, Bangladesh, to identify the prevalence and risk factors of CVDs in this population. Methods: This prospective observational study was conducted over a six-month period at a public health camp in Sreemangal, Bangladesh. A total of 137 adult participants were purposively selected. Data were collected through a structured questionnaire and physical examination, including measurements of blood pressure and laboratory analysis of blood samples. Results: The study found that 44.53% of participants had elevated blood pressure, and 21.90% had stage 1 hypertension. Interestingly, 36.50% of participants were unaware of their hypertension status. Furthermore, 26.28% of participants had a known history of diabetes, but blood glucose level analysis revealed an additional 14.85% of participants were prediabetic, and 6.93% were diabetic based on fasting blood glucose levels. A statistically significant association was found between increasing age and the stage of hypertension (p<0.001), and between fasting and normal blood glucose levels and the stage of hypertension (p<0.005 and p<0.05, respectively). Conclusions: The findings of this study underscore the need for targeted interventions to prevent and manage CVDs in the adult population of Sreemangal, Bangladesh. These interventions should include regular screening for CVD risk factors, health education to increase awareness of these risk factors, and strategies to promote healthy lifestyle behaviors.

A retrospective study on the surgical management and outcome of congenital diaphragmatic hernia in neonates

Background: Congenital diaphragmatic hernia is a developmental disorder in the anatomy of the diaphragm, which can range from the presence of a thin sac to the frank absence of part of the diaphragm. It results in protrusion of abdominal contents in the chest. CDH once considered as a surgical emergency is no longer a valid dictum. But definitive management of CDH is the surgical correction of defect. Study the demographics, presentation, diagnosis, and surgical outcomes of congenital diaphragmatic hernia (CDH) repair without significant associated congenital anomalies at a tertiary care institute. Methods: This was a retrospective study over 3 years from January 2021 to December 2023. Data was collected and noted from the medical records department. Patient抯 clinical data in terms of demography, presentation, radiology, preoperative condition, timing of surgery after admission, intra-operative findings and post-operative course (including postoperative complications, duration of NICU stay, the incidence of sepsis, and need of inotropes), etc. Results: Most patients were male (85%). Among the total cohort, 70% were born outside the tertiary care institute and were referred from peripheral hospitals. Respiratory distress was the predominant complaint (85%). Congenital diaphragmatic hernia (CDH) was incidentally discovered in 5% of neonates. The majority of patients (70%) underwent surgical intervention between the 3rd postnatal day and up to one week. Left-sided herniation was observed in 90% of cases. An identifiable hernial sac was found in 18% of patients, with part or the entirety of the stomach being the most frequently encountered herniated viscera. Conclusions: Congenital diaphragmatic hernia (CDH) presents as a significant congenital anomaly in the pediatric surgery domain. Hidden mortality in case of CDH leads to underreporting of the actual incidence of the condition. The success of surgical intervention depends on a myriad of factors, encompassing patient-specific attributes and surgical methodologies. However, instances devoid of overt congenital anomalies and featuring stable preoperative physiological parameters typically yield satisfactory surgical outcomes, with favorable results.

Esophageal achalasia, an unexpected complication of COVID-19 post palatoplasty: a case report and literature review

The COVID-19 pandemic, caused by SARS-COV-2, has led to significant mortality worldwide. Despite the declaration in May, 2023 by the World Health Organization (WHO), that the COVID-19 pandemic in no longer a public health emergency of international concern, some survivors are experiencing post-infection complications, including esophageal achalasia. Esophageal achalasia is a rare neurodegenerative disorder characterized by impaired esophageal motility and lower esophageal sphincter dysfunction. This study reviews the literature to explore the association between COVID-19 and achalasia and also presents a case of a 9-month-old child diagnosed with achalasia following COVID-19 infection; a unique occurrence in a young child. This study comprises a case report and a literature review. Clinical data for the case report was collected from medical records, while the literature review included a search of electronic databases from January 2020 to October 2023. Keywords related to COVID-19 and esophageal achalasia were utilized to conduct a search in electronic databases resulting in 9 selected articles. This study underscores the emerging concern of esophageal achalasia as a post-infection complication of COVID-19. It provides a unique case of a young child developing achalasia after COVID-19 infection and reviews the limited literature on this association. Further research is needed to understand the underlying mechanisms and potential preventative measures for this rare complication in COVID-19 survivors.

Long-term maintenance and complications of fixed dental prostheses

Fixed dental prostheses (FDPs), commonly known as dental bridges, play a pivotal role in restorative dentistry, offering patients a means to regain oral function and aesthetics in cases of tooth loss. These prosthetic devices, anchored to natural teeth or dental implants, bridge the gap created by missing teeth, improving chewing, speech, and smile aesthetics. However, the successful deployment of FDPs requires not only their initial placement but also long-term maintenance and an understanding of potential complications. Effective oral hygiene, regular dental surveillance, and professional dental cleanings are essential for preserving FDP longevity. Vigilance is crucial as FDPs, while resistant to cavities themselves, can pose challenges in cleaning around abutment teeth. Complications, including dental caries, periodontal issues, crown or bridge fractures, abutment tooth deterioration, aesthetic alterations, sensory sensitivity, and even prosthetic failure, are potential concerns. Timely intervention and preventive measures are key to addressing these issues. When complications arise, dental practitioners can often repair superficial problems like crown fractures. Profound or recurrent complications may require more extensive interventions, such as fabricating a new bridge or considering alternative restorative options like dental implants or removable partial dentures. By embracing these principles of maintenance and management, patients can optimize the durability and functionality of their FDPs while minimizing associated risks, ensuring a healthy and confident smile for years to come.

Navigating the caregiver’s strain: psychosocial well-being among sandwich generation caregivers in India

Background: Sandwich generation caregivers, while providing simultaneous care to two generations, face unique challenges and responsibilities. This research tried to understand the intricate aspects of this caregiving paradigm, with an emphasis on the difficulties faced by the sandwich generation in India and its impact on their psychosocial well-being. Methods: The study used the Montgomery Borgatta caregiver burden scale to measure the burden experienced by the caregivers. Furthermore, both bivariate and multivariate analyses were done to understand the effects of background factors on the burden experienced by the caregiver. Results: The findings demonstrate significant associations with demographic characteristics such as age, caste, education, income, religion, and employment status, emphasizing the multidimensional nature of the burdens. Younger caregivers experienced greater objective and demand burdens, suggesting that the caregiving challenges intensify as caregivers age. Higher education and income were associated with increased subjective demand burden, possibly due to higher expectations and greater responsibilities. Conclusions: The study results highlight the critical need for tailored support systems that identify and address the unique issues of sandwich generation caregiving. As population ageing continues to impact societies worldwide, understanding and addressing the concerns of sandwich generation caregivers is crucial for the well-being of individuals, families, and communities.

A rare case of symptomatic bilateral pheochromocytoma

Pheochromocytoma with reported incidence of 2-8 per million, is a rare and special tumor with its own unique clinical and pathological features, originating from the amazingly intelligent neuroendocrine cells of chromaffin cells of the adrenal medulla. It may behave as 慻reat masquerader� and be sweet and predictable as a child, while at times act as a 憈reacherous murderer� crashing and tearing everything in its path with fierce rage, the main cornerstone of the disease being surgical excision. Here, we report a rare case of middle aged female presenting with hypertensive crisis which necessitates intensive care unit (ICU) management where she responded well to anti-hypertensives and radiological investigations were suggestive of bilateral pheochromocytoma. The course of treatment consisted of array of investigations to ascertain the diagnosis before embarking on bilateral adrenalectomy keeping in mind the consequences of absence of adrenal and subsequent possibility of Nelsons syndrome, which we were able to treat successfully. Here we want to highlight the consideration of bilateral adrenal tumors as a differential diagnosis for suprarenal growths, subsequent surgical course and post-operative medical treatment highlighting the importance of mineralocorticoids and glucocorticoids for day to day functioning.

A rare combination of ileal duplication cyst with mesenteric cyst in 8 months old child: a case report

Enteric duplication cysts are rare congenital lesions that can develop anywhere along the alimentary tract and vary greatly in presentation, size, location and symptoms. Duplications most commonly arise from the mesenteric border of the intestine and are frequently single. These are classified as cystic or tubular. Mesenteric cysts are rare intra-abdominal lesions occurring during childhood period, which may vary in presentation and can be asymptomatic or can present as obstruction, perforation or bleeding. The diagnosis of duplication cyst is difficult due to absence of obvious pathognomic signs. Abdominal ultrasound and computed tomography may aid in diagnosis. Radiological imaging may not be sufficient and high index of suspicion is needed to diagnose such cases. We herein are presenting the rare case of combination of mesenteric cyst with enteric duplication cyst in 8 months old child who reported to surgical emergency with complaints of bleeding per rectum. Ileal duplication cysts are rare anomalies which are often underreported because of their vague symptomatology and radiological features are often not diagnostic. A high index of suspicion is always needed to pick up the diagnosis based on history, examination and radiological findings.

Guarana (Paullinia cupana) as a potential tool for mesenchymal stromal cells priming in regenerative medicine

Mesenchymal stromal cells (MSCs) have therapeutic potential due to their abilities of differentiation, immunomodulation, and migration to injured tissues, potentiating such effects when cells are activated. Guarana (Paullinia cupana) is a tropical plant species found in South America that is known for its antioxidant, stimulant, and cicatricial effects. The guarana extract is composed of many substances and caffeine is the main component. The objective was to evaluate the effects of guarana and caffeine on MSCs. After the initial characterization, MSCs were treated with Paullinia cupana (10, 100, and 1000 μg/mL) or caffeine (0.4, 4, and 40 μg/mL) for 24 h. MSCs treatment with 1000 μg/mL guarana increased cell polarity, viability, cell migration to chemoattractant, antioxidant potential, and liberation of extracellular vesicles (EVs), while it reduced the levels of autophagy. MSCs treated with 100 and 1000 μg/mL guarana or 40 μg/mL caffeine showed a decrease of cell proliferation. No treatment affected the cellular area and cell cycle of MSCs. The study shows in vitro evidence that guarana could be a promising alternative for activating MSCs to promote better cellular products for future clinical therapies.

The use of biomarkers in the diagnosis and management of emergency medical conditions

The use of biomarkers in emergency situations represents a change in modern healthcare. This review examines their impact in emergencies focusing on how they improve the accuracy of diagnoses, provide insights into prognosis and aid in treatment decisions. Notably troponins (I and T) are effective in diagnosing myocardial infarction enabling targeted interventions and risk assessment for cardiovascular emergencies. In cases of sepsis procalcitonin helps distinguish infections and influences decisions about therapy, which is crucial for global efforts against resistance. S100B, a biomarker used in emergencies assists in prioritizing cases of brain injury. To prevent harm, serum markers like creatinine and cystatin C guide interventions for hepatic emergencies. For trauma and hematological emergencies D dimer and lactate provide prognostic information. Ongoing research is exploring biomarkers well as the integration of artificial intelligence offering promising advancements for the future. The clinical significance of biomarkers highlights a commitment to approaches that contribute to the ever-evolving field of emergency medicine and ultimately enhance patient care.

An overview of periodontal disease in pregnancy

Periodontal disease (PD), an inflammatory and infectious condition affecting the tissues supporting teeth, is prevalent among pregnant women due to hormonal changes. Studies indicate a link between PD and adverse pregnancy outcomes, including preterm labor and low birthweight newborns, likely due to increased inflammatory mediators. Oral pathogens like Tannerella forsythia and Porphyromonas gingivalis have been associated with these complications. The most prevalent oral conditions affecting pregnant women that may influence the course of their pregnancy are periodontitis, gingivitis, and dental caries. From supragingival plaques to subgingival infections and PD, these conditions are linked to one another. Elevated maternal serum antibodies to these pathogens and inflammatory markers correlate with poor pregnancy outcomes. Animal models further support the connection between PD and fetal health issues. While research suggests that periodontal treatment may reduce the risk, the exact mechanisms remain complex and multifactorial. Integrating dental care into prenatal care is vital for prevention and management.

Components and outcome of triple antibiotic paste and its application in endodontic infections

In the field of endodontic therapies, the use of antibiotics, especially in the form of root canal medications, plays a pivotal role in ensuring successful treatment outcomes. This review examines the role of triple antibiotic paste (TAP) in such therapies, delving into its composition, application, and effects on endodontic infections. TAP, a combination of metronidazole, ciprofloxacin, and minocycline, targets the diverse microbial flora in odontogenic infections. Its local application within the root canal space proves more effective than systemic administration, significantly reducing microbial count and aiding in tissue regeneration and disinfection. However, the use of TAP is not without challenges, as it can cause tooth discoloration, particularly due to minocycline, and raise concerns about antibiotic resistance and long-term biocompatibility. This study, conducted through a comprehensive literature search, evaluates the efficacy of TAP, its impact on tooth structure, and its role in maintaining the vitality of diseased pulp. The findings highlight TAP’s significant role in endodontic treatments, emphasizing its benefits in achieving therapeutic goals while acknowledging the need for careful consideration of its drawbacks.

Pathogenesis, diagnosis, and management of dentin hypersensitivity

Dentin sensitivity is a problem characterized by brief sharp pain that occurs in response to things like changes in temperature, sweet or sour substances and mechanical factors. This condition significantly affects the lives of patients leading to restrictions and changes in oral hygiene routines. It is crucial for care to understand the causes, symptoms, diagnosis and management of dentin sensitivity. The development of dentin sensitivity is closely related to the structure of teeth which involves the exposure of tubes in the dentin that contain nerve endings sensitive to stimuli. Different theories, such as the theory and direct innervation theory provide insights into how this pain occurs. Diagnosis involves an evaluation of signs and symptoms along with patient history and specific tests to confirm sensitivity. Management options include adjusting behaviors using desensitizing toothpaste or fluoride applications utilizing bonding agents or even undergoing procedures like gingival grafts. These approaches aim to reduce pain and improve the quality of life for individuals affected by dentin sensitivity. Dental professionals play a role, in diagnosing, treating and educating patients about this condition to ensure results and better oral health.