Human thelaziasis in Bangladesh.

Very few cases of Human Thelaziasis are reported worldwide. This is the first case of its kind from Bangladesh. A 58 years old man was admitted to Ophthalmology department of Mymensingh Medical College Hospital, Mymensingh, with itching, redness, foreign body sensation, lacrimation & filamentary discharge from right eye (R/E). He had visual acuity <6/60, conjunctival congestion & advanced bi-headed pterygium of R/E. After exposure of R/E ball with universal eye's speculum, a thin white nematode was found into the right lower conjunctival fornix. It was taken out by a plain forceps, placed into a bottle containing Hartman's solution & immediately sent to Microbiology department of Mymensingh Medical College for proper identification. Subsequently with the joint collaboration & detailed examination by the Parasitology department of Bangladesh Agricultural University (BAU), Mymensingh, the nematode was identified as an adult Thelazia callipaeda worm.

Clinical microbiology in the intensive care unit: strategic and operational characteristics.

Infection is a major cause of morbidity and mortality among patients admitted in intensive care units (ICUs). The application of the principles and the practice of Clinical Microbiology for ICU patients can significantly improve clinical outcome. The present article is aimed at summarising the strategic and operational characteristics of this unique field where medical microbiology attempts to venture into the domain of direct clinical care of critically ill patients. The close and strategic partnership between clinical microbiologists and intensive care specialists, which is essential for this model of patient care have been emphasized. The article includes discussions on a variety of common clinical-microbiological problems faced in the ICUs such as ventilator-associated pneumonia, blood stream infections, skin and soft tissue infection, UTI, infection control, besides antibiotic management.

Clonidine as an analgesic adjuvant to continuous paravertebral bupivacaine for post-thoracotomy pain.

We prospectively evaluated the effect of clonidine as an adjuvant to bupivacaine for continuous paravertebral intercostal nerve block, measuring pain and sedation scores and pulmonary function tests. Thirty patients scheduled to undergo thoracotomy were randomized to receive either a bolus of 0.125% bupivacaine 2 mg/kg (group BUP) or 0.125% bupivacaine 2 mg/kg with clonidine 2 microg/kg (group BUP+CLO), followed by an infusion of 0.125% bupivacaine at 0.5 mg/kg/h, or 0.125% bupivacaine at 0.5 mg/kg/h with clonidine at 2 microg/kg/h, in respective groups, through a paravertebral intercostal catheter. Haemodynamic parameters, pain and sedation scores and pulmonary function tests were recorded at 6, 12, 24 and 48 hours after arrival in postoperative care unit. There were significantly lower pain scores at rest and on coughing in group BUP+CLO compared with group BUP (P <0.01). Multiple comparisons revealed a significant reduction in pain score at each time point (P<0.01), except at 12h to 24h, in group BUP+CLO. Sedation scores were significantly higher in group BUP+CLO compared with group BUP at each time point (all P<0.01). There was a linear effect of time on sedation score in group BUP whereas in group BUP+CLO, the effect was quadratic. Patients in the clonidine group had a higher incidence of hypotension (P < 0.01). There was no significant difference in pulmonary function between the groups. We conclude that using clonidine as an adjunct to bupivacaine for continuous paravertebral intercostal nerve block improves pain relief after thoracotomy, but hypotension and sedation are adverse effects interfering with its clinical application.