Rotavirus A (RVA) is a dominant causative agent of acute gastroenteritis in children worldwide. G2P[4] is one of the most common genotypes among human rotavirus (HRV) strains, and has been persistently prevalent in South Asia including Bangladesh. In the present study, whole genome sequences of a total of 16 G2P[4] HRV strains (8 strains each in 2010 and 2013) detected in Mymensingh, north-central Bangladesh were determined. These strains had typical DS-1-like genotype constellation. Most of gene segments from DS-1 genogroup exhibited high level sequence identities to each other (>98%), while slight diversity was observed for VP1, VP3, and NSP4 genes. By phylogenetic analysis, individual RNA segments were classified into one (V) or two-three lineages (V–VI or V–VII). In terms of lineages (sublineages) of 11 gene segments, the 16 Bangladeshi strains could be further classified into four clades (A-D) containing 8 lineage constellations, revealing the presence of three clades (A-C) with three lineage constellations in 2010, and a single clade (D) with four constellations in 2013. Therefore, co-existence of multiple G2P[4] HRV strains with different lineage constellations, and change in clades for the study period were demonstrated. Although amino acids in the antigenic regions on VP7 and VP4 were mostly identical to those of global G2P[4] strains after 2000, VP4 of clade D RVAs in 2013 had alanine and proline at positions 88 and 114, respectively, which are novel substitutions compared with recent global G2P[4] strains. Replacement of lineage constellations associated with unique amino acid changes in the antigenic region in VP4 suggested continuous genetic evolutionary state for emerging new G2P[4] rotavirus strains in Bangladesh.
Telmatoscopus albipunctatus, is a medically important insect, distributed throughout moist environments that may potentially cause myiasis. Urinary myiasis and other sites of infestation including the intestine, nasal passages, lung and skin have been reported. This is the first case report of an Indian patient infected with T. albipunctatus in the Paramilitary setup. The 40 year male Paramilitary Force serving personnel reported to the
Liposomal amphotericin-B (AmBisome) is now becoming first choice for the treatment of visceral leishmaniasis (kala-azar) patients due to high efficacy and less toxicity. The reported incidence of hypersensitivity reactions to liposomal amphotericin-B (AmBisome), especially during therapy, is very rare. We report two patients with kala-azar: one developed breathing difficulties and hypotension followed by shock and the other had facial angioedema with chest tightness during treatment. Both patients were managed with immediate action of injection: adrenaline, diphenhydramine and hydrocortisone. In our experience, AmBisome can cause severe hypersensitivity reactions that warrant proper support and close supervision.
This report describes a case of an infant of 5 months presenting with cephalohematoma since birth which was initially soft but later became hard and calcified after two months with the history of aspiration at one and half month of age. Surgical intervention using discard of the inner lamella and the cap radial craniectomy technique was used. The patient recovered uneventfully thereby. This report describes an infant presenting with a large calcified cephalohematoma leading to the surgical intervention using cap radial craniectomy. While the exact incidence is not known, large calcified cephalohematoma is rarely reported in the literature. We discuss here thoroughly the anatomy, classification, pathogenesis and different reconstructive surgeries of calcified cephalohematoma.
Hypokalaemia is a common clinical condition, very often the cause of which can be determined by the patient’s clinical history. Gitelman’s syndrome is an inherited renal tubular disorder that must be considered in some cases of hypokalaemia. We present this case of a 48-year-old male patient admitted in our nephrology department for recurrent hypokalaemia. The patient had generalized seizure followed by unconsciousness, generalized weakness, fatigue, palpitation, orthostatic hypotension and polyuria for one month. Patient was on treatment for systemic hypertension with amlodipine and olmesartan. On blood gas analysis, he had a metabolic alkalosis (pH 7.53; pCO2 40 mm Hg; HCO3 34.1mmol/l). Biochemical analysis revealed hyponatremia (105.8mmol/l), hypokalemia (2.07mmol/l), hypochloraemia (74.0mmol/l), hypomagnesaemia (1.10mmol/l) and hypocalcaemia (7.2 mg/dl). Serum creatinine (1.9 mg/dl) and blood urea (6.3mmol/l) were normal. Further investigations revealed hypocalciuria (0.5mmol/l; NR 2.5–7.5) and increased urinary excretion of sodium (210.0 mmol/l; NR 20–110), Potassium (35mmol/l) and chloride (220mmol/l; NR 55–125). Renal ultra-sonogram was normal. A diagnosis of Gitelman’s syndrome was established. We started treatment with sodium chloride, potassium chloride and magnesium sulfate supplementation. Serum potassium was stabilized around 3mmol/l and the patient had significant clinical improvement. The aim of our article is to remind Gitelman’s syndrome in the differential diagnosis of persistent hypokalemia and to highlight the need for further investigations in patients with recurrent hypokalaemic episodes. This rare, inherited, autosomal recessive renal tubulopathy is associated with several genetic mutations in the thiazide-sensitive sodium chloride co-transporter and magnesium channels in the distal convoluted tubule. Patients with Gitelman’s syndrome present during adolescence or adulthood as an inherited autosomal recessive traits with a wide range of clinical presentations from being asymptomatic to predominant muscular symptoms such as fatigue, weakness in association with hypocalciuria, hypomagnesemia with hypermagnesuria and normal prostaglandin production. Clinical suspicion should be raised in those with recurrent hypokalaemic paralysis with metabolic alkalosis associated with hypomagnesaemia. Treatment of Gitelman’s syndrome consists of long-term potassium and magnesium salt supplementation. In general, the long-term prognosis and life expectancy is excellent. CBMJ 2021 January: vol. 10 no. 01 P: 54-58
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