Melioidosis is not widely recognized in Bangladesh which is evident from the paucity of published reports on melioidosis from this region. Here, we summarize the clinical presentation, laboratory results, prevention and control policies and make important recommendations for patient management. A 35-years-old diabetic male forest officer from Gazipur Sadar located north-west of Dhaka city got admitted to Shaheed Suhrawardy Medical College Hospital, Dhaka with history of recurrent fever for last 1 year. Initially the fever was high grade (upto 105 0 F), intermittent nature and lasted for a few days to week. About five months back, the patient developed a parietal abscess over the left lumber region and was treated surgically accordingly. The patient then gradually recovered and remained afebrile for about one month. Fever again recurred, high grade, quotidian in nature and has been persistent for the last 3 months. The patient had also developed marked loss of appetite, altered bowel habit with occasional vomiting and lost about 15kg of his body weight. The patient noticed profuse watery diarrhea for last 2 days and got himself admitted. On examination, the patient was found wasted, conscious but slow mentation, dehydrated and moderately anaemic. His pulse was 116/min, blood pressure 80/60 mm Hg, respiration 24/min and oral temperature was 103 0 F but no palpable lymph nodes. The patient had moderate hepato-splenomegaly with left sided pleural effusion and bilateral depressed ankle jerks. Burkholderia pseudomallei was isolated and identified by blood and urine culture as well as with serological test. We should be more alert among the diabetic patients who are presented with fever with high ESR and neutrophilic leucocytosis, even if radiography or cytopathology is indicative of tuberculosis. [Bangladesh J Infect Dis 2015;2(1):23-26]
Diabetic nephropathy is a major microvascular complication of diabetes, representing the leading cause of end stage renal disease in the world, and a major cause of morbidity and mortality in type 2 diabetic subjects. In the kidney, a number of pathways that generate reactive oxygen species (ROS) such as glycolysis, specific defects in the polyol pathway, uncoupling of nitric oxide synthase, xanthine oxidase, NAD (P) H oxidase, and advanced glycation have been identified as potentially major contributors to the pathogenesis of diabetic kidney disease. Changes in oxidative stress biomarkers, including superoxide dismutase, catalase, glutathione reductase, glutathione peroxidase, glutathione levels, vitamins, lipid peroxidation, nitrite concentration, nonenzymatic glycosylated proteins have been associated with diabetic nephropathy due to oxidative stress induced hyperglycemia. Oxidative stress in diabetes is responsible for endothelial dysfunction releasing inflammatory markers cytokines from the damaged renal tissue. Hyperglycemia induces intracellular reactive oxygen species in mesangial and tubular epithelial cells which induces cytokines, IL-6 and TNF-α production in glomerular mesangial and tubular epithelial cells in diabetic kidney. Antioxidants inhibit high glucose induced transforming growth factors and extra cellular matrix expression in glomerular mesangial and tubular epithelial cells, which ameliorate features of diabetic nephropathy, suggesting that oxidative stress plays an important role in diabetic renal injury causing diabetic nephropathy.
Chronic obstructive pulmonary disease (COPD), characterized by an airway obstruction caused by emphysema, chronic bronchitis, or both, is a common and growing clinical problem that is responsible for a substantial worldwide health burden. We present a case of a 61 years old former heavy smoker with a known case of COPD having shortness of breath which gradually increased in severity and present even at rest (MRC Grade IV) and increased purulence and volume of phlegm. Digoxin, hydrocortisone, and ceftriaxone were administered to manage the exacerbation as emergency procedure along with nebulized oxygen. The patient was nebulized with the mixture of salbutamol, ipratropium, and normal saline. Later, parenteral medication was shifted to oral therapy, i.e., antibiotic (azithromycin) and corticosteroid (prednisolone). The symptoms improved with the appropriate medication.
Complementary and Alternative Medicine (CAM) is a group of diverse medical and health care systems, practices and products that are not presently considered to be a part of conventional medicine. Primary reasons for the use are to relieve symptoms associated with chronic, even terminal illnesses or the side effects of conventional treatments or having a holistic health philosophy or cultural belief. In Nepal, the Ayurvedic system is most widespread and reasons for this had no or less side effect as well as more effective for chronic patients. Drug interactions can occur at the pharmaceutical, pharmacodynamic, or pharmacokinetic level. Herbals and dietary supplements containing St John’s Wort (Hypericum perforatum), ginkgo (Ginkgo biloba), kava (Piper methysticum), digitalis (Digitalis purpurea), willow (Salix alba), magnesium, calcium and iron were documented to have the most interactions with individual medications. Warfarin, insulin, aspirin, digoxin, and ticlopidine had the greatest number of reported interactions with those preparations. Since, half of the Nepalese populations use CAM therapy, the healthcare professionals should pay attention towards such interactions. DOI: http://dx.doi.org/10.3126/jcmc.v3i2.8433 Journal of Chitwan Medical College Vol.3(2) 2013 1-3
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