Kawasaki disease (KD) is an acute self-limiting inflammatory disease associated with vasculities, affecting predominantly medium sized vessels and encountered these cases infrequently in clinical practice. The most concerning complication is coronary artery aneurysm (CAA) leading to myocardial infarction or sudden death. Fever is the essential feature. Kawasaki disease is invariably associated with an inflammatory process with elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell count. Early recognition and treatment with IVIG (Intravenous venous immunoglobulin), and Aspirin showed highest protection against development of coronary artery disease. Incidence of KD is more in East Asia or in Asian ancestry living in other countries. The reason for high incidence in developing country is still unknown. Recently a significant number of cases attended in day to day practice which led conducting this study to assess the pattern of presentation, management and outcome after treatment and to aware the health care providers about the nature of the disease. This observational study conducted during September 2014 to March 2016. All the cases reported to the department of paediatric echocardiography for coronary artery analysis and suspected as KD were included in the study. History, clinical examination and investigation reports were analyzed from records. Age, gender, clinical feature, management, follow-up, echocardiography findings and outcome were analyzed. Data were collected from records of Echocardiography Department and Paediatric Cardiology Department of Lab Aid Cardiac Hospital and Combined Military Hospital, Dhaka. Among 27 cases, 16 were male (49.25%) and 11 were female (40.75%). Age distribution showed 8 (29.63%) were under one year of age, 13(48.14%) were in 1-5 years age group, 6 (22.23%) were in more than 5 years age group. All 27 cases were presented with fever, strawberry tongue, conjunctivitis, skin rash with peeling. Raised ESR, CRP and neutrophilic leukocytosis were found in all 27 cases. Cervical lymphadenopathy was found in 15 (55.52%) cases. Coronary artery changes were observed in 24 cases (88.89%). IVIG was given in 25 (92.60%) cases and Aspirin was given in 27 cases. Complete cure was achieved in 25 (92.59%) cases and one case died from thrombo-embolic event of radial artery and amputation of hand. The outcome of KD depends on the severity of coronary artery involvement. Patients with aneurysm larger than 08 mm are at highest risk of myocardial infarction. Less than 08 mm aneurismal dilatation regress with time. In this series outcome was excellent due to timely diagnosis and proper intervention.
Background: Magnesium deficiency has been a common, but easily ignored, electrolyte abnormality. Studies on magnesium in our country are lacking. Here, we have estimated and correlated serum magnesium levels with outcomes and other electrolyte imbalance in critically ill patients with respect to the mortality, in hospital outcome and length of high dependency unit (HDU) stay. Methods:A prospective, observational study was conducted in patients who had been admitted to the HDU. Patient's demographic profile, medical history, serum magnesium, calcium and electrolytes were enrolled on admission. Patients were divided into normomagnesemic, hypomagnesemic hypermagnesemic groups and compared for various parameters.Results: Out of 60 critically ill-patients, 32 patients (53.33%) were hypomagnesemic, 20 patients (33.33%) were normomagnesemic and 8 patients (13.33%) were hypermagnesemic. The duration of stay of the patients in HDU, in hospital outcome and mortality showed significant variation between these groups. Associated electrolyte abnormalities in hypomagnesemic patients were hypokalemia (56.25%) and hypocalcemia (62.50%). Most of the hypomagnesemic patients were hypertensive (62.50% vs 40%) and was presented in drowsy state (50% vs 40%) compared to normomagnesemic group. Mortality of hypomagnesemic group was 37.50% while that of hypermagnesemic group was 25%. In hospital, arrythmia (18.75%) and convulsion (12.50%) developed in hypomagnesemic groups. Mean duration of length of stay in HDU was 7.45 days in hypomagnesemic, 6.83 days normomagnesemic, and 8.67 days in hypermagnesemic group.Conclusion: Development of magnesium imbalance in critically ill patients is associated with bad prognosis. Monitoring of serum magnesium levels may have prognostic, perhaps therapeutic implication.
Disease-Modifying Antirheumatic Drugs (DMARDs) play a vital role in the management of Rheumatoid Arthritis (RA). This update aims at focusing some important and novel aspects of biological DMARDs. Recent advances in biological therapy have opened a new window of opportunity for this potentially crippling disorder particularly patients refractory to conventional DMARDs. Close association of cytokine network in the pathophysiology of rheumatoid arthritis has facilitated the development of new biological agents and revolutionized the treatment. Novel drugs such as anti-tumor necrosis factor-alpha (anti-TNF-?) (eg, certolizumab), anti-interleukin-1 (anti-IL-1) (eg, anakinra), anti-interleukin-6 (antiIL-6) (eg, tocilizumab), T-cell depletor (eg, abatacept), anti-cluster differentiation 20 (anti-CD-20) (eg, rituximab) have recently joined with the existing biological therapy in the arena of RA. Emerging agents like adhesion molecule inhibitors, anti-interleukin-15 (anti-IL-15), fusion protein-cytotoxic T-lymphocyte-associated antigen 4-immunoglobulin G1 (CTLA4Ig) are also under investigations. Higher potency, quicker onset of action, less frequency of administration are the main advantages as opposed to potential serious side effects such as infection susceptibility, injection site reaction, Systemic Lupus Erythematosus-like (SLE-like) and Multiple Sclerosis-like (MS-like) symptoms and higher price. Combination of biologicals is not recommended because of higher rate of adverse events and lack of additive effects. But biological DMARDs in combination of Methotrexate (MTX) are now a preferred choice of many rheumatologists. The last but not the least option for aggressive and refractory patients of RA is biological DMARDs. DOI: http://dx.doi.org/10.3329/jafmc.v10i1.22933 Journal of Armed Forces Medical College Bangladesh Vol.10(1) 2014
Sensitivity pattern of isolates from patients’ specimens associated with infection, admitted to the critical care centers with empiric or prophylactic antibiotic use were assessed. Till identification of the organism and resultant sensitivity awaited; and compared with sensitive antibiotic to the isolates which could be used for management. This analytical cross sectional study carried out during the period of April 2016 to July 2016 in the Critical Care Centre (CCC) of Combined Military Hospital, Dhaka Cantonment. Urine and other specimens including wound swab, pus, sputum, tracheal aspirate, catheter tip, nasal swab, high vaginal swab, broncheoalveolar lavage, blood, urethral discharge were collected from the patients following aseptic precautions. Isolate identification was done using standard procedures at the Armed Forces Institute of Pathology (AFIP). Sensitivity was tested using antibiotic disc diffusion technique. A total of one thousand six hundred and seventy patients were dealt with in the study, and positive yield obtained in 190 (11.38%) cases. Of those, 116 were urine specimens which constituted 69 (57.76%) female and 47(42.24%) male patients. A total of 1088 discs of antibiotics were used on an average 9 discs per isolate. Six hundred and forty nine (59.65%) showed resistance to the antibiotic used against them, while four hundred and thirty nine (40.35%) showed sensitive response. The study population was of 2-80 years age group. Other specimens included 74 isolates, fifty (67.57%) were males and twenty four (32.43%) were females. A total of eight hundred and twenty seven (11.18 discs per isolate) antibiotic doses were used 479 (57.92%), showed resistant and 348 (42.08%) sensitive result. Enteric gram negative bacilli (GNB) were the majority of isolates in both types of specimens. The study indicated that, newer antimicrobials have a substantial impact in decreasing human morbidity and mortality rates. It encourages to expand surveillance of antibiotic resistance determinants and to exercise caution in dispensing antibiotics to maximize their continued efficacy. Excess or injudicious use is causing increase in cost as well as inducing drug resistance among the common bacterial isolates. A work on the clinical presentation with trends of antimicrobials used in the CCC setup right now in tertiary care hospital would be of supplemental value for the study.
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