Management and outcome of different drug overdose cases in a tertiary care hospital – A prospective observational study

Background: Overdose is defined as any substance that is exposed excessively, which is intended for consumption. There are many drugs which are used therapeutically, but sometimes self-harm can be done with medications such as analgesics, antiepileptics, and sedatives. The high mortality and morbidity associated with drug overdose could be due to various factors such as easy availability, improper regulations for dispensing drugs, lack of control for over the counter drugs. Aim and Objective: The purpose of this study is to document the incidence of drug overdose cases, sociodemographic characteristics, and its management in a tertiary care hospital. Materials and Methods: A prospective, observational study was conducted from January 2014 to December 2014 at Casualty and Medicine Department in a tertiary care hospital. Results: A total of 61 cases were included in the study. Drug overdose cases were seen in the age group of 21–30 years (67.2%). Intentional drug overdose is seen in 58 (95.08%) cases. In this study, 34.4% of patients presented to the hospital within 6 h of event. Paracetamol was the most common (32.7%). In most of the paracetamol overdose, cases were treated with N-acetyl cysteine, phenobarbitone overdose with forced alkaline diuresis, benzodiazepines overdose with flumazenil, and opioids overdose with naloxone. This study shows that 93.3% of patients had an uncomplicated course of stay in hospital. Conclusion: Drug overdose is a major public health concern in the society. The most vulnerable population in the society is the younger age group. Prevention strategies should be dealt in this high risk group.

Drug rash with eosinophilia and systemic symptoms, uncommon and commonly missed

Drug Rash with eosinophilia and systemic symptoms, also called DRESS syndrome, is a rare form of drug induced hypersensitivity reaction that presents with skin eruptions, blood count abnormalities (eosinophilia) and internal organ involvement (lung, kidney, liver), making it life threatening at a rapid pace. The most commonly affected organ is liver, mimicking condition similar to acute hepatitis.

Efficacy of 5-(2-aroyl)aryloxy methyl-2-phenyl-1,3,4-oxadiazoles as antibacterial and antifungal agents.

Research and development of potent and effective antimicrobial agents represent one of the most important advances in therapeutics; the main aim of these efforts is not only control the serious infections, but also prevention and treatment of some infectious complications of other therapeutic modalities. A series of 5-(2- aroyl)aryloxy methyl-2-phenyl-1,3,4-oxadiazoles were screened for their antibacterial and antifungal activities. Anti-bacterial activity against B. cereus, S. aureus, B. subtilis, S. aureus (MRSA), E. aerogenes, M. luteus, K. pneumonia, P. aeruginosa, S. typhimurium, E. coli, paratyphi-B, P. vulgaris bacterial strains and anti-fungal activity against C. albicans, A.niger, F.solani, A.flavus, B.cinerea, C.krusei, M. pachydermatis, C.parapsilosis, F.moniliforme, C.gloeosporioides fungal strains were carried out. The bioassays indicated that most of the synthesized compounds showed potential antibacterial and anti-fungal activity.

A case of battered wife.

The use of corrective force against the wife is still rife in all cultures and even socially acceptable in some culture. Domestic violence is still common in our society. We report a case of 20 years old woman who admitted into OCC of DMCH through emergency department owing to be assaulted by her husband. This case is exceptional one because the injuries inflicted upon her were over the middle of the forehead and clean cut in nature, though non fatal. Awareness and education is needed to stop this social stigma.

Numbers of Purkinje Cell with Increasing Age-A Post Mortem Study.

The change in the number of Purkinje cells with increasing age is evident especially in disorders of fine movement, equilibrium, hypotonia, postural changes, and disturbances of voluntary movement. The present study was done to see the changes in the number of Purkinje cells per square mm in different age groups of Bangladeshi people. This cross sectional descriptive type of study was designed and done in the Department of Anatomy, Dhaka Medical College, Dhaka, from January to December 2010, which was performed on the cerebellum of 28 Bangladeshi people, collected during autopsy examination of unclaimed dead bodies from Department of Forensic Medicine. Paraffin blocks of cerebellum were cut at 5mm thickness and stained with routine Harris' Haematoxylin and Eosin (H & E) stain. Estimation of number of Purkinje cell was done by using the counting circle and examined under the light microscope. The mean ± SD of number of Purkinje cell was 160.71 ± 24.47 in group A (Age 20-29 years) and 152.20 ± 6.49 in group D (age> 50 years), the mean reduction was 2.5% per decade. Histological studies revealed the number of Purkinje cell per square mm decreased with age which was statistically significant and further cytological study of Purkinje cell with larger sample size is recommended.

FVC, FEV, and FEV, FVC% in Type 2 Diabetes and Their Relationships with Duration of the Disease.

Background: Diabetes mellitus is a chronic debilitating disease affecting various organs including lungs. The magnitude of the complications of this disease is related to its duration. Objective: To observe FVC, FEV1 and FEV1/FVC% in type 2 diabetic patients and their relationship with duration of the disease. Methods: This cross-sectional study was carried out in the Department of Physiology, BSMMU, Dhaka, from July 2007 to June 2008 on 60 type 2 diabetic male patients of age 40-60 years (Group B). For comparison, 30 age and BMI matched apparently healthy non diabetic subjects (Group A) were also studied. Patients were selected from the out patient department of Bangladesh Institute of research on diabetes, endocrine and metabolic diseases. Based on duration of diabetes, diabetic patients were divided into B1 (5-10 years) and B2 (10-20 years). FVC, FEV1 and FEV1/FVC% of all the subjects were measured by a digital microspirometer . Data were analyzed by One way ANOVA test, Unpaired Student’s ‘t’ test and Pearson’s correlation coefficient test as applicable. Results: Mean of the percentage of the predicted values of FVC and FEV1, were significantly (p<0.001) lower in both those of Gr. B1and B2 than that in A and were also significantly (p<0.001) lower in Gr. B2 when compared with Gr. B1. Again, FEV1/FVC% was significantly (p<0.01)higher in Gr. B2 than those in Gr. B1 and A whereas this value was lower in Gr. B1than those of group A but it was not statistically significant. However, FVC and FEV1 showed negative and FEV1/FVC% showed positive correlations with duration of diabetes. All these correlations were statistically non significant. Conclusion: From the result of this study it can be concluded that the ventilatory function of lung may be reduced in type 2 diabetes which may be related to the duration of the disease.

FVC, FEV1 and FEV1/FVC%, In Postmenopausal Women and Their Relationship with Serum Progesterone and Estrogen Level.

Background: Exacerbation of asthma associated with worsening of lung function has been reported in women after menopause. The relationship between lung function and female sex hormones has been documented in postmenopausal women. Objective: To observe FVC, FEV1 , FEV1/FVC%, serum estrogen and progesterone levels in apparently healthy postmenopausal women to find out their interrelationships. Methods: This cross sectional study was carried out in the Department of Physiology, from 1st January 17to 31st December 2007 in BSMMU, Dhaka. 30 postmenopausal women aged 45 to 60 years and 30 premenopausal women aged 20 to 30 years during different phases of menstrual cycle were studied. FVC, FEV1and FEV1/FVC%, were measured by RMS computer based Spirometer. Estrogen and progesterone levels were estimated by Micro particle Enzyme Immunoassay (MEIA) method. Data were analyzed by Pearson’s correlation coefficient test, one way ANOVA and unpaired‘t’ test. Results: The mean percentage of predicted values of FVC and FEV1 were significantly (p<.001) lower in postmenopausal women compared to those of follicular and luteal phases of premenopausal women. Mean serum estrogen and progesterone levels were significantly lower in postmenopausal women compared to any phases of menstrual cycle of premenopausal women. In postmenopausal women, FVC, FEV1 showed positive correlation with progesterone but negative with estrogen level.FEV1/ FVC% Showed negative correlation with both serum estrogen and progesterone level. All these correlations were statistically non significant. In premenopausal women FEV1 and FEV1/FVC% showed positive correlation and FVC showed negative correlation with serum estrogen level in follicular phase and FVC, FEV1 showed positive and FEV1/FVC% showed negative correlation with serum estrogen level in luteal phase. Again FVC, FEV1 and FEV1/FVC% showed positive correlation with serum progesterone level in follicular and luteal phases of menustrual cycle. Conclusion: The out come of this study shows FVC, FEV1 may be reduced in postmenopausal women which in turn may be associated with low progesterone and estrogen levels.

Histological variant of nephrotic syndrome with atypical presentation in children.

Aims of the present study were to find out the histological pattern of atypically presenting nephrotic syndrome children and their response with oral corticosteroid therapy. This prospective study was carried out in the Paediatric Nephrology unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, for a period of two years, from September 2001 to September 2003. Forty children with nephrotic syndrome with atypical presentations such as gross haematuria, renal impairment, hypertension and hypocomplementaemia were enrolled for the study. For each patient proper investigations were done to screen out infection and necessary treatment was given accordingly. Renal biopsy was done in all cases after treating infection and controlling hypertension and specimen were evaluated by light and immunoflourescence microscopy. All the patients were treated with oral prenisolone 60 mg/m2/day for 4 weeks and response were observed by heat coagulation test. In present study it was observed that mean age of presentation was 8.73+/-4.36 years. Hypertension, gross haematuria, impaired renal function and hypo-complementaemia were observed in 50%, 45%, 19% and 15% cases respectively. When histopathologies were considered, 90% cases had other than minimal change disease (MCD) and Mesangial proliferative glomerulonephritis (MesPGN) was the most common histopathology (47.5%). Regarding steroid therapy only 43.2% patients were responsive to oral prednisolone therapy within 28 days. Atypically presented nephrotic syndrome usually manifested with higher age of onset, gross haematuria, hypertension, renal insufficiency and hypocomplementaemia. Mesangial proliferative glomerulonephritis was the predominant histological type. The majority (56.8%) of these atypically presented nephrotic syndromes were resistant to steroid therapy.

Comparison between DOT EIA IgM and Widal Test as early Diagnosis of Typhoid Fever.

A recently developed DOT enzyme immunoassay known as "Typhidot" for detecting IgM antibody against 50 KDa OMP antigen of Salmonella typhi, was evaluated on 100 clinically suspected typhoid fever cases and 40 age-sex matched controls, in the Department of Microbiology, Mymensingh Medical College during, the period from June 2006 to July 2007. Blood culture, Widal test, and DOT EIA for IgM test were performed in all patients. Among 100 clinically suspected typhoid fever cases, 35 were subsequently confirmed on the basis of positive blood culture for S. typhi and/or significant rising titre of Widal test. The DOT EIA IgM test could produce results within 1 hour. The result of the DOT EIA IgM test showed a good diagnostic value for typhoid fever. The sensitivity, specificity, positive and negative predictive value of the test was found as 91.42%, 90.00%, 88.88% and 92.30% respectively. On the other hand corresponding values for Widal test were of 42.85%, 85.00%, 71.42% and 62.96% respectively. Thus, The DOT EIA IgM seems to be a practical alternative to Widal test for early diagnosis of typhoid fever.

A case of renal transplantation.

A 12-year-old boy was admitted in paediatric nephrology unit of Bangabandhu Sheikh Mujib Medical University (BSMMU) with massive proteinuria, hypertension, respiratory distress and anaemia and diagnosed as nephrotic syndrome. Percutaneous needle biopsy was consistent with diffuse endocapillary proliferative glomerulonephritis and initially managed conservatively with injection methyl prednisolone, cyclophosphamide, lisinopril etc. without any improvement. Living-related renal transplantation was done successfully from paternal uncle. Two episodes of acute rejection occurred, one immediately after transplantation and another after one month. These were managed with IV methyl prednisolone for 3 days. At present, he is on oral prednisolone, cyclosporine, azathioprine and antihypertensives with normal haemoglobin and stable serum creatinine level (pre-transplant level 12.5mg/dl to post-transplant level 1.5mg/dl). He has been maintaining his normal life including schooling for last few months. It is concluded that a patient with uncommon presentation of nephrotic syndrome should be confirmed by renal biopsy and renal transplantation may be considered if conservative measures fail.

Congenital nephrotic syndrome, an uncommon presentation of cytomegalovirus infection.

Cytomegalovirus (CMV) infection is a very rare infection in children as well as in infancy. In CMV infection extra renal manifestations in central nervous system (CNS), eyes and hematological are prominent and common than renal manifestation. We are describing two case reports one at the age of 5 months and another at one month with features of both extra renal and renal manifestations of nephritic syndrome. Our first case presented with predominant features of CNS manifestations like convulsion and spastic monoplegia, sensory type of deafness and absence of light reflexes along with nephritic features. Deafness and absence of light reflex were confirmed by audiometric and ophthalmological examination and brain atrophy was confirmed by CT scan. Our second case had features of hypothyroidism along with nephritic features. Hypothyroid status was confirmed by elevated serum TSH level and reduced T4 level. In both cases nephritic features were confirmed at bed site urine examination by heat coagulation test and other relevant investigations. CMV infection was confirmed in both cases by detecting anti CMV IgM by ELISA method. Both patients were clinically improved with intravenous gangcyclovir therapy. In these two cases reports, clinical, serological and therapeutic observation established the causal relationship between the CMV infection and nephrotic syndrome.

Do all regularly menstruating women ovulate in each cycle?

Women may experience anovular menstruation due to some pathophysiological causes which can be detected either by invasive histological examination as well as noninvasive serial ultrasound test. The women who are regularly menstruating without ovulation in each cycle were identified in this study. In a tertiary level infertility care centre of Bangladesh in Dhaka infertile population was the subject of the study. The serial ultrasound noninvasive procedure is used for diagnosis of anovular menstruation and found very much helpful.

Correlation of ultrasonographic findings with ultrasound guided fine needle aspiration of liver lesion.

Ultrasonographic findings of liver were correlated with cytological findings in a series of 50 patients. Multiple lesions described by ultrasonography and suggested as HCC/TB were proved to be metastatic in 60% cases and hepatocellular carcinoma in 40% cases by cytological examination. Multiple lesions suggested as metastatic lesions in ultrasonography was proved as such by cytology in 83% cases. Solitary lesion suggested as neoplastic in ultrasonography was proved as such in cytology in 90% cases. Of the 2 patients suggested as diffuse parenchymal lesion revealed cytological findings of cirrhosis in one case and that of TB in other. Serum alpha-feto protein and Carcinoembryogenic antigen (CEA) was done in all the cases. Serum alpha-feto protein was higher in hepatocellular carcinoma and CEA was higher in metastatic lesions. Ultrasound guided fine needle aspiration of liver can play more role in diagnosis and classification of liver disease than ultrasonographic comment alone, as it requires greater degree of precision to reach diagnostic accuracy.

Unnatural deaths during Zakat distribution.

Zakat is an islamic religious directive to wealthy Muslims to distribute 2.5% of their total annual saving to the poor. Before Eid-ul-Fitr Zakat is distributed to share happiness and joy with the poor. Deaths due to stampede in uncontrolled crowds of poor during Zakat distribution made it a point of study. In this tragic accident during Zakat distribution on 26.4.91 at a Biri (cigarette) factory (10 k.m. away from the port city of Chittagong), the total number of deaths were 32, out of which 27 (84.37%) persons died of Traumatic Asphyxia and 5 (15.63%) from head injury and more than 100 were injured, mostly elderly female and children. The young and elderly male escaped.

A psycho-social study on genito-urinary fistula.

This study was done on a series of 132 vesico-vaginal fistula (V.V.F.) cases to assess the social factors that are related to this morbidity and its psycho-social effects on them. About 54% of the respondents developed VVF as an outcome of their first pregnancy and none of them had a living child. Of this 39% were in the age group of 15-20 years. About 68% were illiterate and 22% had received formal education for up to 5 years. Fifty two per cent of the subjects had a family income of up to Tk. 1,000 only per month. Almost all were Muslims (94.7%). Of the respondents 64.6% had home delivery by TBA and 72% had history of prolonged labour. Fifty six per cent of the subjects did not like to avail the health facilities of the nearby clinic/hospital. Lack of privacy, objection from husband/family and conduction of delivery by male doctor were mentioned as causes for not availing the facilities by this large group. Indifferent attitude of husband and in-laws, expressed willingness of husband for taking another wife, disturbed socio-psycho-sexual life and deterioration of general health were the after effects of the morbidity at individual, conjugal and community level of the respondents.

Psychosomatic effects of permanent sterilization.

A follow-up study of 300 tubectomy and 300 vasectomy cases was conducted in the urban, semiurban and rural areas of Mymensingh district. Psychosomatic effects of these individuals were recorded through interviews using a pretested questionnaire. Results indicated that illiterate, economically insolvent and persons having children up to 2 to 3 years of age were the clients. Growing size of the family was the main concern for adopting sterilization. Professional motivators were found more effective in motivating vasectomy cases. In both groups there was no significant change in libido. In case of vasectomy 99% were found sexually active by the 30th post-operative day while 52% of the tubectomy cases were sexually active by the six weeks of post-operative days. From this study it appears that further in-depth study might be necessary in probing more insight of the psychosocial basis of sterilization and effects thereof.