RESUMO
Background: Drug resistant Salmonella spp. continues to remain a health problem as last two decades have witnessed the emergence and spread of multidrug resistance against conventional anti-typhoid drugs. Multidrug resistant (MDR) typhoid is now a serious problem in many developing countries including Bangladesh. Objectives: To find out antimicrobial sensitivity and resistance patterns of different types of Salmonella spp. in patients with enteric fever and to find out the epidemiological strains (e.g. resistant strain, epidemic strain, MDR strain) in patients with enteric fever. Materials and Methods: This cross-sectional study was done during October 2009–November 2010 and January–December 2012 at United Hospital Limited, Dhaka. Laboratory reports of blood culture were collected from those patients who were investigated as suspected cases of enteric fever. Both the indoor and outdoor patients were enrolled in the study. Salmonella species resistant to one or more of the first line drugs were divided into resistant strain, epidemic strain and multi-drug resistant strain. Results: During the period October 2009–November 2010, total 210 subjects were enrolled. Among the participants, 122 were male and 88 were female. S. typhi were found in 133 samples whereas 76 were S. paratyphi A and only 1 S. paratyphi B. Sensitivity was found 77% for ampicillin, 91.4% for cotrimoxazole, 78.6% for chloramphenicol, 87.6% for ciprofloxacin, 96.6% for cefixime, 98% for ceftriaxone and only 22.1% for azithromycin (77.9% resistant). Total 91 (43.3%) cases were found having resistant strain, 6 (2.8%) epidemic strain and 8 (3.8%) MDR strain Salmonella spp. The sensitivity of azithromycin was analyzed among different categories of strains and revealed that 52.7% showed resistance in resistant strain, 100% in epidemic strain and 87.5% in MDR strain. During the period between January–December 2012, total 139 subjects were enrolled. Among the participants 68 were male and 71 were female with a ratio of 1:1.04. S. typhi were found in 84 cases whereas 55 were S. paratyphi A and no S. paratyphi B. Sensitivity was found 62.7% for ampicillin, 82% for cotrimoxazole, 83% for chloramphenicol, 45.2% for azithromycin, 95% for ciprofloxacin, 99.3% for cefixime and 100% for ceftriaxone. Total 55 (39.6%) cases were found having resistant strain, 3 (2.1%) epidemic strain and 17 (12.2%) MDR strain Salmonella spp. Against azithromycin 67.3% showed resistance in resistant strain, 33.3% in epidemic strain and 29.4% in MDR strain. Conclusion: The policy of empirical treatment of enteric fever needs to be rationalized and newer generation antibiotics should be restricted only for multi-resistant cases of enteric fever.
RESUMO
Background: Chronic obstructive pulmonary disease (COPD) is usually associated with polycythemia. It is assumed that systemic inflammatory components of COPD can interfere with erythropoietin and can result in anemia of chronic disease which will impair the functional capacity of these patients and also increase morbidity and mortality. Objective: To evaluate anemia status in COPD patients. Materials and Methods: This cross-sectional study was conducted in clinically stable 50 COPD patients in the outpatient department of Medicine in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of July to December 2011. The demographic characteristics, smoking habit, duration of disease, types and severity of anemia, BMI and results of 6-minute walk test were recorded. Results: Out of 50 COPD patients, 76% were male and 24% were female. Among them 32% patients were anemic, 20% were polycythemic and 48% patients had normal hemoglobin. Among the anemic patients with COPD, 87% were male and 13% were female,75% were mildly anemic and 4% moderately anemic, 62.5% had normocytic and 37.5% had microcytic anemia. Conclusion: Anemia in COPD patients is often overlooked and underestimated. Clinicians should be aware of the presence of anemia in patients with COPD so that appropriate treatment could be initiated to improve the quality of life and prognosis.
RESUMO
Myasthenia gravis is the most frequent autoimmune neuromuscular transmission disorder with incidence of 2-20 patients per million. Its pathophysiology is autoimmune, with acetylcholine receptor auto antibodies damaging the post-synaptic fold at the muscle membrane. The diagnostic confirmation of myasthenia gravis is often challenging. Ice-oneyes test can be used to diagnose this disease for its simplicity, safety and cost-effectiveness. Here we report a case of myasthenia gravis in Enam Medical College Hospital, Savar, Dhaka where ice-on-eyes test was done with improvement of ptosis of the patient. Aim of this case report is to make aware our physicians to apply this simple bed side test instead of common traditional edrophonium (tensilon test) test for confirmation of the diagnosis of ocular myasthenia gravis.
RESUMO
Background: Poisoning with various substances is a global problem. It is one of the most important reasons for emergency admission in the hospital. The earlier the initial resuscitations, gastric decontamination and use of specific antidotes, the better is the outcome. Epidemiology of poisoning differs from region to region. This study was carried out to determine the pattern and severity of poisoning in a tertiary care hospital. Objective: To characterize the poisoning cases admitted in Enam Medical College Hospital. Materials and Methods: All cases admitted to the emergency department of Enam Medical College Hospital during the period of April to December, 2010 were evaluated retrospectively. We reviewed data obtained from the hospital medical records and included the following factors: demographic characteristics, etiology and outcome of the acutely poisoned patients. Total 84 poisoning cases were found and they were included in the study. Results: The overall case fatality rate was 3.5%. More detailed data from 2010 reveals that two-thirds of the patients were 20-30 years old, 53% male and 47% female. Organophosphorus was the most common cause (73.9%) followed by unknown poisoning (9.5%), sedative (5.9%), harpic (4.7%), aluminium phosphide (2.4%), savlon (1.2%), paracetamol (1.2%) and amitryptiline (1.2%). 90.5% cases were suicidal and 9.5% were homicidal. Conclusion: This study provides important information on the characteristics of the poisoning in this region. Community education about the danger of the drugs and reduction of exposure to pesticides are recommended.