Background: Snake bite and the subsequent envenomation is an important health hazard which may lead to fatality in rural areas of Bangladesh. Objective: This study was conducted to evaluate the epidemiology, clinical profile, treatment and outcome for patients with snake bite admitted in the intensive care unit of Dhaka Medical College Hospital, Bangladesh. Methodology: This prospective cohort study was conducted in the Department of Anaesthesia, Analgesia, Palliative and Intensive Care Medicine, Dhaka Medical College, Dhaka, Bangladesh from May 2019 to April 2020 for a period one year. The patients of snake bite were treated in the Intensive care unit, Dhaka Medical College Hospital, Dhaka, Bangladesh. A questionnaire, containing information on bite, physical examination and identification of snake was used. Results: A total number of 23 patients of snake bite were treated in the Intensive care unit. Among the patients, 16 (69.56%) were bitten by cobra, 2 (8.6%) were suspected to be bitten by krait and 5(21.7%) cases had Russel viper bite. Tight tourniquet was used in 15(65.21%) cases. Among the patients 18(78.26%) patients were observed with the features of neurotoxicity with or without local envenoming. Among all patients, one patient required two doses of ASV, another patient needed 3 doses; but the other patients were found to be improved after getting a single dose of ASV. However, 15 patients needed ventilator support. The mean duration of ventilator support was 4.8 days. The mortality was 30.43% (7 patients). Out of these 7 patients, 4 patients died due to acute renal failure with DIC. Conclusion: Neuroparalytic Cobra envenomation is accounted for the highest incidence of venomous bites in the present study. Journal of Current and Advance Medical Research, January 2022;9(1):48-55
Background: Sepsis related troponin elevation (SRTE) has always been the demand and supply mismatchtheory. In the setting of sepsis, the cardiac metabolic requirements are high and in order to meet theserequirements an increase in the coronary blood flow is needed. Patients with underlying anemia andpreexisting subclinical CAD may develop a mismatch ischemia in this setting. It was always thought thatsepsis-related hypotension causes a decrease in coronary perfusion pressure thus leading to a decreasedblood flow to cardiac myocytes and thereby leading to SRTE. Objectives: To establish Troponin-I as a useful diagnostic marker for sepsis. Settings and Study Design: This prospective study was carried out in the department of Anesthesia,pain, palliative and intensive care medicine, Dhaka Medical College, Dhaka during July 2013 to June2015. Methods: This study was carried out in the department of Anesthesia, pain, palliative and intensive caremedicine, Dhaka Medical College, Dhaka during July 2013 to June 2015. According to Troponin-I valuepatients were divided into Troponin-I positive and negative for sepsis. Three cut off values of Troponin-I(0.05, 0.035, 0.015) were used for this study. By using Receiver operating characteristic (ROC) curve thebest sensitively, specificity, negative predictive value and positive predictive values of Troponin-I weredetermined. Results: The validity of troponin I (>0.05 ng/dl) evaluation for blood culture positive were sensitivity45.0%, specificity 53.8%, accuracy 48.5%, positive predictive values 60.0% and negative predictive values38.9%. The validity of troponin I (>0.035 ng/dl) evaluation for blood culture positive were sensitivity57.5%, specificity 23.1%, accuracy 43.9%, positive predictive values 53.5% and negative predictive values26.1%. The validity of troponin I (>0.015 ng/dl) evaluation for blood culture positive were sensitivity72.5%, specificity 15.4%, accuracy 50.0%, positive predictive values 56.9% and negative predictive values26.7%. Conclusion: The cutoff values of troponin-I (>0.035 ng/dl) observed more sensitivity of blood culture. JBSA 2018; 31(1): 3-11
Background: Acute respiratory distress syndrome (ARDS) necessitates rapid recognition for early intervention and favourable outcomes. The Berlin Definition may not be always helpful for ARDS diagnosis in critically ill patients, because of the inability to acquire adequate information from bedside chest X-rays. Lung ultrasound may be a reasonable alternative to chest X-ray for the identification of ARDS, but the effectiveness of lung ultrasound in ARDS diagnosis remains uncertain. Objective: To explore the efficacy of lung ultrasound (LUS) for the diagnosis of ARDS in ICU. Methods: This observational, cross-sectional study was conducted in the ICU, DMCH at the Department of Anaesthesia, Analgesia, Palliative, and Intensive Care Medicine from March 2017 to June 2019. Lung ultrasound was performed on acute hypoxic respiratory failure patients requiring mechanical ventilation. chest X-ray, arterial blood gas analysis, and echocardiography were done to fulfill the Berlin Definition. ARDS was diagnosed by the ‘CXR-based Berlin Definition’ and ‘LUS-based Berlin Definition’. Results: A total of 141 patients were assessed. Their median age was 35 years. Primary diagnoses were sepsis, pulmonary oedema, pneumonia, and trauma. A total of 62 (43.97%) patients fulfilled ‘CXR-based Berlin Definition’ and a total of 69 (48.93%) patients were diagnosed as ARDS by ‘LUS-based Berlin Definition’. Considering the ‘CXR-based Berlin Definition’ as the reference standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ‘LUS-based Berlin Definition’ were 90.3%, 83.5%, 81.2%, 91.7%, and 86.5% respectively. Conclusion: Lung ultrasound can be an effective tool for the diagnosis of ARDS in the intensive care unit. Bangladesh Crit Care J September 2022; 10(2): 104-109
Background: One of the ways of modulation of septic response is glycaemic control. Increased Bloodglucose variability rather than mean glucose level in critically ill patients is an important factorassociated with sepsis. Objective: Objective of this study was to find out whether the increased blood glucose variabilitypredicts mortality for septic patients in Intensive Care Unit. Methods: Purposively allocated 40 septic patients in Intensive Care Unit of Dhaka Medical CollegeHospital, Bangladesh were observed prospectively from January 2012 to July 2013. Glucose variabilitywas assessed within first twenty four hours of recruitment of septic patients. By considering a targetblood glucose level (5 - 8 m mol/L), the assigned patients were separated into three groups (accordingto blood glucose variability). Group I (mild variable group) included those patients having less than twoblood glucose values not within the target blood glucose level. Group II (moderate variable group)included those patients having more than two to four blood glucose values not within the target range.Group III (more variable group) included those patients having more than four blood glucose values outof range of target glucose level. Chi- square test along with a p-value (< 0.05) was done to assess whichgroup of blood glucose variability best reflects the association of mortality. Logistic regression was usedto determine the odds ratio of ICU death in relation to blood glucose variability. Results: Out of all the septic patients, the more blood glucose variability group (37.5%) more reflectedthe blood glucose variability than the others. Using the Chi-square, it was found that a highlysignificant difference (x2-14.56, p-value 0.001) was existed between three blood glucose variabilitygroups with respect to mortality. Logistic regression analysis demonstrated that more glucosevariability group had predicted higher mortality rate with a p- value of 0.007 and an odds ratio of 16.0.Result is significant. On the other hand, significant effect of moderate glucose variability group onmortality was not found with a p-value of 0.665 and an odds ratio of 0.667. Conclusions: The septic patients having more blood glucose variability had predicted higher mortalityrate than that of moderate and less blood glucose variability in Intensive Care Unit. This observationindicates that blood glucose variability should be included as a future approach to glucose managementof septic patients as a target for therapeutic intervention. JBSA 2022; 35 (2) : 43-50
Background: The pathophysiological mechanism involved in the occurrence of hypotension and bradycardia following central neuroaxial blockade is peripheral vasodilatation, parasympathetic dominance and increased baroreceptor activity.Current studies correlate these haemodynamic changes with activation of a phenomenon naming Bezold-Jarisch reflex (BJR). 5-Hydroxytryptamine-3 is an important factor associated with inducing BJR and Ondansetron antagonizes the induction of BJR. Objective: To compare the efficacy between ondansetron and ephedrine as prophylactic against spinal anaesthesia induced hypotension and bradycardia. Method: 120 mothers of ASA grade I and II scheduled for elective caesarean section under spinal anaesthesia were selected and randomized into two equal groups naming Group A(n=60) and Group B (n=60). Group A received Ondansetron IV (0.1mg/kg body wt) and group B Ephedrine (0.15 mg/kg body wt) 5 minutes prior spinal anaesthesia. Data were recorded before and just after anaesthesia and at two minutes intervals up to 10th minute followed by five minutes intervals until the end of surgery. Results analyzed using unpaired t-test. A “P” value < 0.05 was considered statistically significant. Result: Group A showed slight but statistically significant higher heart rate than after Group B at 10th min and 15th min (P=0.001). Statistically significant higher values of MAP in Group A found up to the 15th minute of perioperative period. Rescue medications for hypotension were significantly higher in Ephedrine group. Shivering is common for both groups ,whereas nausea and vomiting is significantly less in group A. Conclusion: Ondansetron and Ephedrine has potential role to prevent spinal anaesthesia induced hypotension and bradycardia but Ondansetron shows better efficacy. Ondansetron also plays important role in prevention nausea and vomiting. JBSA 2016; 29(2): 67-74
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