Ocular Manifestation and Correlation with CD4+ T Cell Count among Adult HIV/AIDS Patients in Bangladesh.

Patients with HIV or AIDS suffer from wide varieties of complications that are related to infection. The eye as an organ is not spared from HIV-related manifestations. The ocular manifestations can be the presenting sign of a systemic infection in an otherwise asymptomatic HIV-positive person. The disease can have adnexal, anterior segment, posterior segment, orbital and neuro-ophthalmic manifestations. The objective of the study was to evaluate the ophthalmological manifestations among adult HIV infected patients of Bangladesh and co-relate the findings with CD-4+ T cell count. This cross sectional study was conducted in the department of Community Ophthalmology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2013 to September 2015. Purposive sampling technique was applied to enroll the patients. Total 110 patients were enrolled regardless of their immunological status by inclusion and exclusion criteria. Relevant clinical evaluation including history & physical examinations, laboratory investigations and some ocular examinations like- visual acuity, slit lamp biomicroscopy, IOP, indirect ophthalmoscopy with +90D (diopter) and +20D were done. The age of the study population ranged from 20-58 years with mean±SD 37.63±8.16 years. Among the study population 67(60.9%) were male and 43(39.1%) were female. According to ART status, 58(52.7%) were on ART and 52(47.3%) were ART naive. The mean CD4+ T- cells count was 410±281.65 with minimum to maximum was 6-1266 cells/µl. Among them 53(48.2%) had HIV related ocular findings and 57(51.8%) had no HIV related ocular manifestation. In relation with CD+ T- cells count, highly significant relation was found with lower CD4+ T- cells count and ocular manifestation (p=0.001).

Anatomical variations of median nerve formation, distribution and possible communication with other nerves in preserved human cadavers.

Formation, distribution and possible communication of the median nerve are essential to know in treatment and surgeries of various conditions of injuries e.g. repair or reconstruction of the median nerve post traumatic accident. In the present study, 44 upper limbs were dissected. Root forming the median nerve, the median nerve in relation with the axillary artery and communication of the median nerve with other nerves were noted.

Methanol Induced Toxic Amblyopia--A Case Report.

A 28-year-old man, smoker having history of occasional alcohol intake--was admitted in the Department of Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU) with gradual diminution of vision in both eyes 10 days after consumption of homemade alcoholic beverage in a wedding ceremony. His initial acuity of vision was limited to no perception of light in right eye and hand movement in left eye. Fundus examination revealed pale optic discs in both eyes. The patient was treated with Injection Methylprednisolone 1000 mg intravenous slowly over 1 hour for 3 consecutive days. This was followed by oral prednisolone 60 mg daily for 14 days and then gradually tapered over 4 weeks. The patient also received Injection Hydroxycobalamine and Injection Folinic Acid for 2 weeks. On the 3rd day of treatment there was perception of light in the right eye and on the 10th day the visual acuity improved to hand movement. In the left eye, the visual acuity gradually improved to 6/60 on 3rd day and on 10th day improved to 6/24. Four weeks later, the visual acuity had recovered in both eyes to 6/18. Combination of intravenous and oral steroid along with vitamin B1 and folinic acid has been found effective in treating severe methanol induced optic neuropathy.

Multiwall carbon nanotube polyvinyl alcohol-based saturable absorber in passively Q-switched fiber laser.

In this work, we demonstrated a compact Q-switched erbium-doped fiber laser capable of generating high-energy pulses using a newly developed multiwall carbon nanotube (CNT) polyvinyl alcohol (PVA) thin film based saturable absorber. Q-switched pulse operation is obtained by sandwiching the thin film between two fiber ferrules forming a saturable absorber. A saturable absorber with 1.25 wt. % of PVA concentration shows a consistency in generating pulsed laser with a good range of tunable repetition rate, shortest pulse width, and produces a high pulse energy and peak power. The pulse train generated has a maximum repetition rate of 29.9 kHz with a corresponding pulse width of 3.49 µs as a function of maximum pump power of 32.15 mW. The maximum average output power of the Q-switched fiber laser system is 1.49 mW, which translates to a pulse energy of 49.8 nJ. The proposed method of multiwall CNT/PVA thin film fabrication is low in cost and involves uncomplicated processes.

Esophagitis dissecans superficialis presenting with massive haematemesis in a patient with bullous pemphigoid.

The stratified squamous epithelial lining of the esophagus is similar to that of the skin, and occasionally conditions that affect the skin tend to have esophageal manifestations. Autoimmune dermatological conditions that present with blisters are referred to as bullous dermatoses and have been found to rarely present with esophageal involvement. Esophageal epithelium is thought to be involved in rare occasions because of its identical epithelial lining to the skin and tends to be more frequent among patients with pemphigus vulgaris than in those with pemphigoid. Common symptoms from esophageal involvement in bullous dermatoses may include heartburn, odynophagia or dysphagia. Rarely, it may present with vomiting of sloughed cast of esophageal mucosa or haematemesis. We present S A, a 47 year old female who was on outpatient treatment in 2010 at King Fahad Medical City for bullous pemphigoid but developed progressive odynophagia with massive haematemesis. She was admitted and resuscitated, and endoscopy revealed sloughing of esophageal mucosa and bleeding in keeping with esophagitis dissecans superficialis. Although association of esophageal dissecans superficialis with pemphigus vulgaris has been sparsely reported; to our knowledge its association with bullous pemphigoid as in our case has been rarely reported in English medical literature.

Serological prevalence of leptospiral infection in wild rats at the National Service Training Centres in Kelantan and Terengganu.

One hundred and sixty eight rats were trapped from the National Service Training Centres (NSTC) in Kelantan and Terengganu from October 2008 to May 2009. Microscopic agglutination test (MAT) was performed to detect the presence of agglutinating antibodies to Leptospira among the rats caught. All the MAT positive rats were identified as Rattus tiomanicus. In Kelantan, 17.3 % (14/81) of the rats had leptospiral antibodies to serovars Icterohaemorrhagiae (12.3%), Canicola (2.5%), Ballum (1.2%), and Pyrogenes (1.2%). In Terengganu, 18.4% (16/87) of the rats had antibodies to serovars Icterohaemorrhagiae (15%), Canicola (1.1%), Pyrogenes (1.1%) and Hebdomadis (1.1%). This study indicated that Leptospira serovars were prevalent in the rat population in the study areas and could be a source of infection to humans. Therefore, control of the rat population in all NSTC is critical to prevent outbreaks of leptospirosis amongst the NSTC trainees.

Serological prevalence of leptospiral infection in wild rats at the National Service Training Centres in Kelantan and Terengganu

One hundred and sixty eight rats were trapped from the National Service Training Centres (NSTC) in Kelantan and Terengganu from October 2008 to May 2009. Microscopic agglutination test (MAT) was performed to detect the presence of agglutinating antibodies to Leptospira among the rats caught. All the MAT positive rats were identified as Rattus tiomanicus. In Kelantan, 17.3 % (14/81) of the rats had leptospiral antibodies to serovars Icterohaemorrhagiae (12.3%), Canicola (2.5%), Ballum (1.2%), and Pyrogenes (1.2%). In Terengganu, 18.4% (16/87) of the rats had antibodies to serovars Icterohaemorrhagiae (15%), Canicola (1.1%), Pyrogenes (1.1%) and Hebdomadis (1.1%). This study indicated that Leptospira serovars were prevalent in the rat population in the study areas and could be a source of infection to humans. Therefore, control of the rat population in all NSTC is critical to prevent outbreaks of leptospirosis amongst the NSTC trainees.

Hepatic encephalopathy: a retrospective analysis.

A review of 34 patients was conducted to investigate the causes of hepatic encephalopathy. Hypokalemia, infection, and gastrointestinal tract bleeding were found to be the usual precipitating factors. Women are affected more commonly, and gastrointestinal tract hemorrhage is usually the terminal event.

A brief review of the adult respiratory distress syndrome.

The adult respiratory distress syndrome (ARDS) is seen with increasing frequency. It is associated with a variety of conditions even in the absence of preexisting pulmonary diseases. The treatment often includes intubation, using positive-end expiratory pressure (PEEP), and other ancillary support. The mortality rate is high, and physicians caring for such patients should be on guard for disseminated intravascular coagulation, gastrointestinal hemorrhage, and infection.

Chronic airways obstruction in pulmonary sarcoidosis: its poor response to bronchodilators.

Emphysema, chronic bronchitis, asthma, and cystic fibrosis are often cited as examples of chronic airways obstruction, while sarcoidosis is typically restrictive. Approximately 15 percent of sarcoidosis patients, however, have airways obstruction clinically characterized by wheezing with granulomatous involvement of airways. Since the majority have Stage IV disease by chest radiograph, their lungs usually have honey-combining with pulmonary fibrosis, adhesions, cavities, and mediastinal distortion.Patients had a mixed ventilatory defect, but obstruction of large airways was present as shown by decreased specific airways conductances. Small airways obstruction was also present as shown by low instantaneous flows at the terminal portion of the maximum expiratory flow-volume curve and diminished helium response of this curve. The closing volume, however, was not very sensitive. Radioactive xenon washout from ventilation lung scans and N2 washout from the lungs were prolonged in patients with worse disease.The authors conclude that the obstructive type of physiologic pattern is more frequent than recognized in sarcoidosis, which like that of cystic fibrosis has some restrictive element and is characterized by poor reversibility to bronchodilators. A trial period of beclomethasone dipropionate aerosol was not helpful in two patients. Relief of this distressing airways obstruction continues to pose a challenging problem in management.