BackgroundMagnetic resonance imaging (MRI) allows detailed study of structural and functional changes in the brain in patients with cerebral malaria.MethodsIn a prospective observational study in adult Bangladeshi patients with severe falciparum malaria, MRI findings in the brain were correlated with clinical and laboratory parameters, retinal photography and optic nerve sheath diameter (ONSD) ultrasound (a marker of intracranial pressure).ResultsOf 43 enrolled patients, 31 (72%) had coma and 12 (28%) died. MRI abnormalities were present in 79% overall with mostly mild changes in a wide range of anatomical sites. There were no differences in MRI findings between patients with cerebral and non-cerebral or fatal and non-fatal disease. Subtle diffuse cerebral swelling was common (n = 22/43), but mostly without vasogenic oedema or raised intracranial pressure (ONSD). Also seen were focal extracellular oedema (n = 11/43), cytotoxic oedema (n = 8/23) and mildly raised brain lactate on magnetic resonance spectroscopy (n = 5/14). Abnormalities were much less prominent than previously described in Malawian children. Retinal whitening was present in 36/43 (84%) patients and was more common and severe in patients with coma.ConclusionCerebral swelling is mild and not specific to coma or death in adult severe falciparum malaria. This differs markedly from African children. Retinal whitening, reflecting heterogeneous obstruction of the central nervous system microcirculation by sequestered parasites resulting in small patches of ischemia, is associated with coma and this process is likely important in the pathogenesis.
Snakebites can present local or systemic envenomation, while neurotoxicity and respiratory paralysis are the main cause of death. The mainstay of management is anti-snake venom (ASV), which is highly effective, but liable to cause severe adverse reactions including anaphylaxis. The types of adverse reaction to polyvalent anti-snake venom have not been previously studied in Bangladesh. In this prospective observational study carried out between 1999 and 2001, in the Snake Bite Study Clinic of Chittagong Medical College Hospital, 35 neurotoxic-snake-bite patients who had received polyvalent anti-snake venom were included while the ones sensitized to different antitoxins and suffering from atopy were excluded. The common neurotoxic features were ptosis (100%), external ophthalmoplegia (94.2%), dysphagia (77.1%), dysphonia (68.5%) and broken neck sign (80%). The percentage of anti-snake venom reaction cases was 88.57%; pyrogenic reaction was 80.64%; and anaphylaxis was 64.51%. The common features of anaphylaxis were urticaria (80%); vomiting and wheezing (40%); and angioedema (10%). The anti-snake venom reaction was treated mainly with adrenaline for anaphylaxis and paracetamol suppository in pyrogenic reactions. The average recovery time was 4.5 hours. Due to the danger of reactions the anti-snake venom should not be withheld from a snakebite victim when indicated and appropriate guidelines should be followed for its administration.
Introduction: In Bangladesh there has been steady increase in aged (>60years) from 5.6% in the year 1981 to more than 7% in the year 2006 and 12% by the year 2025. In Armed Forces we have about 30 to 35% are of aged 60 years and above.Many of them are engaged in life struggle and nation-building activities. They deserve the healthy life access to all health facilities. Objectives: To assess the common health problems of the retired Armed Forces Personnel and to find out necessary steps or quantify measures. Materials and Methods: This was a descriptive type of cross sectional study conducted among the 112 retired Armed Forces Personnel who were admitted in Combined Military Hospital, Dhaka with a view to assess their health problems. The sample was selected purposively and data was collected by face to face interview. Results: The mean age of the respondents was 59.20±7.22 years. The most prevalent diseases among the respondents were hypertension (32.1%), diabetes mellitus (17.0%), bronchial asthma (13.4%), ischemic heart disease (10.7%), and cataract (8.9%). Majority of respondents (57.1%) were unemployed, 28.6% were engaged in business and 14.3% had a job in private company. The association between their health problems and present occupational status was found statistically highly significant (p<0.05). Conclusion: The most common health problems were hypertension, diabetes mellitus, bronchial asthma and ischemic heart disease among the retired Armed Forces personnel. Prevalence almost all the diseases were significantly (p<0.05) associated with employment status. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 45-47
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