Clinical Outcome of Neonatal Septicemia in Bangladesh

Objective: In this study our main goal is to evaluate clinicaloutcome of neonatal septicemia in Bangladesh.Methods: This cross-sectional study is conducted at Neonatalunit of the department of paediatrics, Sir Salimullah MedicalCollege and Mitford Hospital, Dhaka, From July 2005 to June2006. Among 90 clinically diagnosed septicemic neonates, 30were blood culture positive.Results: During the study, where low birth weight (60%),prematurity (53%), prolonged rupture of membrane wasdocumented in 17% of cases. 70% delivery occurred by normalvaginal route, among them 50% occurred at home and 20%occurred at hospital. 30% were delivered by LUCS. 13% caseshad H/O fever in last trimester. Lethargic and reluctant to feed,83% had respiratory distress. Jaundice was present in 60%cases, fever was present in 40% cases. Other presentationswere apnea, convulsion, abdominal distension, sclerema,vomiting, hypothermia and diarrhoea.Conclusion: From our result, we can conclude that, thepattern of organisms are changing and high incidence ofmultidrug resistance remains a major challenge to manageneonatal septicemia.

The Clinical Utility of Serum Albumin and Uric Acid Measurements in Preeclampsia and Eclampsia

Hypertensive disorder of pregnancy affecting multiple systems and woman has dangerously high blood pressure, swelling, and protein in the urine. Therefore serum albumin and uric acid are useful biochemical markers reflecting the severity of the occurrence of preeclampsia and eclampsia. Objective: The aim was to study the role of albumin and uric acid in preeclampsia and eclampsia. Methods: This is the case-control hospital based study carried in the Grant Government Medical College and Sir J.J. Group of Government Hospitals, Mumbai. Normotensive pregnant women (n=50) and women with preeclampsia (n=50) and eclampsia (n=50) were included in the study. Both the groups were in their third trimester and of same age and same gestational age. Serum albumin and uric acid were estimated by BCG endpoint and Uricase – PAP method respectively. Result: The alterations of serum albumin and uric acid levels in preeclampsia and eclampsia pregnant subjects were found as compared to those of control group. A negative and significant correlation (r = -0.492 and -0.602, p < 0.001) was observed between serum albumin with uric acid in study subjects. Conclusion: The results suggest that, albumin and uric acid are important factors in the pathogenesis of preeclampsia and eclampsia and are directly related to the severity of disease.

Prepare today for tomorrow

There has been a rapid advancement in cardiac surgery and anesthesia recently. The burden of cardiothoracic disease in south East Asia especially in Pakistan is on the rise. To meet the challenges of future, the present day cardiologist, cardiothoracic surgeons and cardiothoracic anesthesiologists should be equipped with knowledge and expertise to train work force for future capable to treat the burden of cardiothoracic diseases. The future of cardiothoracic surgery and anesthesia is dependent on the advancements made in recent years in this specialty. It is time that the cardiothoracic anesthesiologists of the country embrace technologies such as transesophageal echocardiography and extracorporeal membrane oxygenation so that they can help in providing safe anesthesia and post-operative care for complex cardiothoracic operations

What diabetics know about diabetes?

Patient's lack of understanding of disease hinders in proper control of disease thus increasing the morbidity and mortality. Review of the studies done in this region, dose not provide a detail account of patients understanding about the disease. Majority of patients when interviewed in clinics do not know the right answer to cause, level of desired sugar, possible complication. Hospital-based cross-sectional KAP study was conducted on diabetic patients visiting the diabetic clinic in two tertiary care Hospitals and a diabetic poly clinic in different areas of Karachi during the month of September 2012. The mean age was 56 years, with 122 male and 118 female, 40.4% patients were uneducated, 22.9% metric, 12.9% intermediate and 22.9% were graduate. Considering the knowledge, as to what is diabetes? only 46% answered correctly. What could cause the disease? 35% thought there was no reason for sugar. Regarding most frequent symptom, 27% thought there were no specific symptoms, 24.2% weight loss and 23.8% excessive urine and 21.7% thought not healing of wound was first indicator and 2.1% thought that increase appetite is the cause. The desired levels of random sugar only 24.2% thought it be around 180 mg /dl while 32.5% had no idea about the value. Desired fasting sugar was correctly known by 34.6% as less than 100 mg/dl and 22.9% as less than 120 mg/dl., Duration of treatment was believed to be life long treatment by 85%. Oral hypoglycemic were consumed by 68%, 24% were on insulin. And 6% were using both.75% patients did not do exercise regularly. Regarding the harms created by diabetes, 51.3% knew that heart or kidneys may get damaged. Regular doctor visits were done by 80%, and 85% were satisfied with the level of care. The average sugar check cost was less than 100 rupees for 62.1%. Lack of proper concepts regarding the disease, desired level of sugars, possible complications could be a big hinder in achieving good diabetic control. Thus by addressing the specific deficiencies in the knowledge and practices of patients, a better outcome may be achievable

Family history of diabetes and parental consanguinity: important risk for impaired fasting glucose in South East Asians / Historia familiar de diabetes y consanguinidad de los padres: riesgo importante para la glucosa en ayunas alterada en Asiáticos Sudorientales

OBJECTIVE: Offsprings of Type 2 diabetics have increased risk of metabolic disturbances. The aim of the study is to assess the potential effect of family history of Type 2 diabetes (FHD) and parental consanguinity on fasting plasma glucose (FPG) levels. SUBJECTS AND METHODS: Non-diabetic offsprings of one or both parents with Type 2 diabetes and healthy controls of comparable age, without a FHD were the subjects of this study. Family history of Type 2 diabetes was defined by the presence of Type 2 diabetes in one or both parents of the subject. Consanguinity was defined as history of marriage with a first cousin. Fasting plasma glucose levels were determined in cases and controls. RESULTS: Impaired fasting glucose (IFG) was identified in 42% ofsubjects with FHD and in 14% without FHD. We found a strong independent association of FHD with impaired fasting glucose in both males and females by logistic regression analysis after adjusting the data for age, gender and body mass index (BMI). Parental consanguinity modifies the effect of FHD on IFG. CONCLUSION: We concluded that family history of diabetes and parental history of consanguinity determine the risk for impaired fasting glucose in this study population.

OBJETIVO: Los hijos con diabetes de Tipo 2 tienen un riesgo mayor de trastornos metabólicos. El objetivo de este estudio es evaluar el efecto potencial de la historia familiar en la diabetes Tipo 2 (HFD) y la consanguinidad de los padres en los niveles de glucosa plasmática en ayunas (GPA). SUJETOS Y MÉTODOS: Los hijos no diabéticos de uno o ambos padres con diabetes de Tipo 2 y controles sanos de edad comparable, sin HFD, constituyeron los sujetos de este estudio. La historia familiar de diabetes de Tipo 2 se definió por la presencia de la diabetes de Tipo 2 en uno o ambos padres del sujeto. La consanguinidad se definió como la historia del matrimonio con un primer primo o prima. Los niveles de glucosa plasmática fueron determinados en los casos y los controles. RESULTADOS: La glucosa en ayunas alterada (GAA) fue identificada en el 42% de los sujetos con HFD y en 14% sin HFD. Se halló una fuerte asociación independiente fuerte de HFD con la glucosa en ayunas alterada tanto en varones como en hembras, mediante el análisis de regresión logística después de ajustar los datos de edad, género e índice de masa corporal (IMC). La consanguinidad de los padres modifica el efecto de HFD sobre la GAA. CONCLUSIÓN: Se llegó a la conclusión de que la historia familiar de diabetes y la historia de consanguinidad de padre y madre determina el riesgo de glucosa en ayunas alternada en la población bajo estudio.

Primary carcinoid tumour of the testis

A left radical orchidectomy was performed on a 32-year-old man presenting with a testicular mass. Histology revealed a tumour comprising of cells with monotonous nuclei and granular cytoplasm arranged in an insular pattern. Immunohistochemical expression for NSE, synaptophysin and chromogranin A were positive. No teratomatous elements were seen. Postoperatively, a staging CT and an octreotide scan were normal. Urinary 5-HIAA levels were not elevated. Based on these investigations the tumour was diagnosed as a pure primary carcinoid tumour of the testis. The patient has been followed up for 3 years with no evidence of recurrence

An unusual scrotal lump

Polyorchidism is a rare anomaly of the genital tract in which supernumerary testes are present, usually within the scrotum. Less than 100 cases have been reported in the literature. We present a case of polyorchidism in which the diagnosis was made on ultrasonography and as there was no evidence of an associated pathology on clinical examination or imaging, surgical exploration was therefore not considered necessary

critical analysis of the management protocols for idiopathic sudden sensori-neural hearing loss

Sudden sensori-neural hearing loss [SSNHL] is a clinical dilemma with great diversity in presentation and poorly understood pathogenesis and hence no definitive treatment protocol as yet. Both sexes are affected, middle age to elderly being the commonest age group. A variety of causes have been implicated as responsible for this condition, but most of the times it is difficult to isolate one, and hence most of the times a battery of investigations proves to be a clinical exercise. A number of treatment protocols have been suggested and used over the years, based on presumed etiological theories, claiming varying degrees of success. Relevant literature available on the net regarding the management and the efficacy of various treatment regimens for ISSNHL was critically analyzed by the authors [who are professorial staff of a medical college and consultants of a teaching hospital] to develop a consensus and recommendations on the most appropriate protocol. It was asserted that various treatment regimens have not proved beyond doubt to be superior to one another or spontaneous recovery rates. SSNHL is a medical emergency that entails thorough investigations to search for a possible cause and institution of appropriate therapy. Failing identifying a cause, i.e idiopathic group, combination therapy with steroids and antiviral drugs could prove beneficial provided treatment is instituted early. A number of placebo controlled trials consuming various modalities are needed to determine an optimal treatment of ISSNHL. Psychological and psychiatric assistance has a certain role and so has the rehabilitation in the management of these patients

Drug resistance in mycobacterium tuberculosis: a four years experience

OBJECTIVE: To assess the prevalence of drug resistance amongst the clinical isolates of M. tuberculosis. SETTING: Armed Forces Institute of Pathology, Rawalpindi. METHOD: Four first line anti-tuberculosis drugs, isoniazid [INH], rifampicin [RIF], ethambutol [ETH] and streptomycin [STR] were tested on 300 isolates from clinical samples, by agar dilution method on Lowenstein Jensen medium. The sensitivities were interpreted by the resistance ratio method. One hundred and fifty eight [52.66%] isolates were found resistant to one drug at least. Among the resistant isolates, 79 [26.33%] were resistant to INH, 72 [24.0%] to RIF, 84 [28.0%] to STR and 70 [23.33%] to ETH with or without resistance to other drugs. Multi-drug resistance [MDR] was found in 41 isolates [13.66%]. To overcome this problem there is a need to establish centres at a number of places all over the country with professionals trained to handle the emerging problem of MDR. Each centre must be equipped with adequate facilities for susceptibility testing so that the resistance pattern can be ascertained and treatment regimens tailored accordingly

outbreak of neonatal sepsis in a nursery

An outbreak of neonatal sepsis caused by a Gram negative bacterium [Klebsiella pneumomae] occurred in the nursery of an eight hundred bedded hospital. Eight neonates were affected and the same strain of Klebsiella pneumonia was isolated front the blood of all the babies. Four of the neonates including the index case expired and four were saved. On investigation the same strain of klebsiella pneumomae was isolated from the resuscitator being used in the nursery. The outbreak was contained by temporarily closing down the nursery and thorough disinfection of its equipment and environment. Such lethal and unfortunate incidents arc a common happening in our setup and can be avoided by the practice of strict aseptic techniques. Careful analysis of the situation and institution of immediate remedial measures arc recommended to contain such outbreaks

Nonvalvular atrial fibrillation and stroke: a review

Nonvalvular atrial fibrillation accounts for more than thirty percent of all strokes above the age of sixty years. The use of anticoagulants for the primary prevention of stroke has been a controversial issue for a long time. New data has emerged which clarifies some of these issues and helps in selecting patients who are at a higher risk of stroke