https://www.banglajol.info/index.php/BCCJ/issue/feedBangladesh Critical Care Journal2023-10-04T08:27:33+00:00Prof. Dr. Mohammad Omar Faruqbccj.editor@gmail.comOpen Journal Systems<p>Official journal of the Bangladesh Society of Critical Care Medicine. Full text articles available.</p>https://www.banglajol.info/index.php/BCCJ/article/view/69162Clinicopathological profile & outcome of critically ill patients suffering from Dengue: Single Centre Experience during COVID Pandemic2023-10-01T11:53:42+00:00Kaniz Fatemadrkanizfatemasb@gmail.comAlimul Haquedrkanizfatemasb@gmail.comASM Areef Ahsandrkanizfatemasb@gmail.comFatema Ahmeddrkanizfatemasb@gmail.comDebasish Kumar Sahadrkanizfatemasb@gmail.comMadhurima Sahadrkanizfatemasb@gmail.comSuraiya Nazneendrkanizfatemasb@gmail.comRozina Sultanadrkanizfatemasb@gmail.comIshrat Jahandrkanizfatemasb@gmail.comTaslima Begumdrkanizfatemasb@gmail.comKhandaker Sabbir Ahmeddrkanizfatemasb@gmail.com<p><strong>Introduction: </strong>Dengue is endemic in our country contributing significantly in morbidity & mortality. This study was conducted to observe the clinic-pathological profile, presentation & outcome of critically ill dengue patients who required Intensive Care Unit admission.</p> <p><strong>Methods: </strong>This observational study was conducted in ICU of a tertiary care hospital in Dhaka city from July 2021 to September 2021. Laboratory confirmed cases of Dengue patients admitted in ICU were included in the study.</p> <p><strong>Results: </strong>Total patients were 40 with equal male-female distribution. Mean age of the patients was 39.17 ± 13.83 years with most of them (70%) in age group of 18-40 years. Direct admission through Emergency Room (42.5%) was more than transfer-in from indoor of same hospital & other hospitals (35% & 22.5% respectively). There were multiple reasons for ICU admission including hypotension (commonest reason), breathlessness, diarrhoea, abdominal distension, altered level of consciousness etc. Only 13 (32.5%) patients had co-morbidities like DM, HTN etc, and mean age of them was significantly higher than patients without co-morbidities (50.3 ± 13.31, vs 32.23 ± 6.88). Biochemical parameters showed that TWBC count was normal in most patients (n=27, 67.5%), thrombocytopenia was present in 35 (87.5%) patients during admission, hypocalcaemia was present in most patients (90%), liver enzymes were raised in most patients (87.5% & 95% respectively for AST & ALT) and three patients had AKI. Twenty percent patients needed vasopressor support for shock & 5% needed mechanical ventilator support for respiratory failure. Clinical condition was improved in 38 patients & most of them (82.5%) were transferred out from ICU within 6 days. Only two among forty patients expired despite resuscitative efforts. There was no significant difference in the biochemical parameters between survivors & non-survivors.</p> <p><strong>Conclusion: </strong>As dengue specific treatment is not yet available, early recognition of the critically ill patients and immediate supportive treatment along with close monitoring in Intensive Care Unit is life-saving for the patients.</p> <p>Bangladesh Crit Care J September 2023; 11 (2): 68-74</p>2023-10-04T00:00:00+00:00Copyright (c) 2023 https://www.banglajol.info/index.php/BCCJ/article/view/69187Role of Nigella Sativa (Black Cumin Seeds) as an Adjunct Therapy in Treating Severe and Critical COVID -19 Infection Compared to Those with Standard Therapy: An Open Label Randomized Clinical Trial2023-10-01T14:20:27+00:00Mohammad Omar Faruqfaruqmo@yahoo.comAmina Sultanafaruqmo@yahoo.comUmme Kulsum Chyfaruqmo@yahoo.comKarishma Shamarukhfaruqmo@yahoo.comChowdhury Tasneem Hasinfaruqmo@yahoo.comMohammed Salah Uddinfaruqmo@yahoo.comSamira Humaira Habibfaruqmo@yahoo.comSusmita Hossain Natashafaruqmo@yahoo.comTamanna Yasmin Shenafaruqmo@yahoo.comTasmia Kashfifaruqmo@yahoo.comMd Gisan Hossainfaruqmo@yahoo.comMd Rashedul Haque Khanfaruqmo@yahoo.comS M Razibul Hasanfaruqmo@yahoo.comMD Saifuddin Sujhonfaruqmo@yahoo.comMehnaz Ferdousfaruqmo@yahoo.comSyed Mahfuzur Rahmanfaruqmo@yahoo.comAhmed Sayeed Arefinfaruqmo@yahoo.comMir Atiqur Rahmanfaruqmo@yahoo.comShamsi Islam Orinfaruqmo@yahoo.com<p><strong>Background: </strong>During recent COVID-19 pandemic (2019-2021) clinician-researchers had been looking for effective treatment of Covid-19 infection. Nigella sativa (NS), a well-known herbal medicine, has beenused asanti-viral, anti-inflammatory, immune modulatory, anti-oxidant, broncho-dilatory, anti-histaminic, anti-tussive activitiesfor patients with mild to moderate COVID-19 infection. Our study aimed to determine the efficacy of NS for treatment of severe and critically ill Covid-19 patients as an adjunct therapy with conventional treatment.</p> <p><strong>Method: </strong>This wasan open label randomized clinical trial conducted in severely and critically ill COVID-19 patients admitted into COVID ICU of United Hospital, Dhaka, Bangladesh. The study subjects were randomly divided into two equal groups: NS group in which subjects received NS orally in addition to the conventional treatment, and Control group, who received conventional treatment only. Primary outcome focused mainly on duration of ICU stay, use of mechanical ventilation (MV)/noninvasive ventilation (NIV)/ High-flow nasal cannula (HFNC) oxygen (HFNO) and mortality. The secondary outcomes were based on comparison of those above mentioned parameters between the groups (NS and Control).</p> <p><strong>Results: </strong>A total of 150 subjects were enrolled according to eligibility criteria.There were 60 deaths (29 NS + 31 Cont.) and 90 survivals (46 NS + 44 Cont.). Among the survivals 16 NS subjects as opposed to 6 Cont. subjects stayed in ICU for 8 to 14 days (P = 0.043). Twenty one subjects of NS group as opposed to 8 subjects of Cont. group stayed in ICU for less than 7 days to 14 days. Whereas among subjects who died there was no significant difference in length of stay among majority of NS and Cont. subjects. NS group required significantly lower number of O2 delivery methods likemechanical ventilation (MV), noninvasive ventilation (NIV),High-flow nasal oxygen (HFNO) compared to their counterparts on Day 7 and Day 14 of stay in ICU.</p> <p><strong>Conclusion: </strong>NS as an adjunct therapy with severe and critical COVID 19 infection was associated with some reduction of duration of stay in ICU but significantly less requirement of invasive and non-invasive ventilator support, high flow nasal oxygen than standard treatment group. Establishing accurately therapeutic efficacy of NS in critically ill COVID-19 patients requires placebo controlled double blind studies.</p> <p>Bangladesh Crit Care J September 2023; 11 (2): 75-82</p>2023-10-04T00:00:00+00:00Copyright (c) 2023 https://www.banglajol.info/index.php/BCCJ/article/view/69186Role of Neutrophil to Lymphocyte Ratio (NLR) and C-Reactive Protein to Albumin Ratio (CAR) as Early Predictors of Severity in Acute Pancreatitis2023-10-01T14:01:29+00:00Nikhil Chandra Roydrgolamazam@gmail.comMd Golam Azamdrgolamazam@gmail.comRiad Mohammad Moshaed Hossaindrgolamazam@gmail.comSarker Mohammed Sajjaddrgolamazam@gmail.comIndrajit Kumar Dattadrgolamazam@gmail.comShireen Ahmeddrgolamazam@gmail.comMd Abdullah Al Mamoondrgolamazam@gmail.comAHM Rowshondrgolamazam@gmail.com<p><strong>Background: </strong>Acute pancreatitis (AP) is a life-threatening disease caused by a variety of factors, and once it progresses to severe acute pancreatitis, the prognosis is poor. Different modalities are available for predicting severity in acute pancreatitis. A single, cheap, widely available marker with high sensitivity and specificity is yet to be identified.</p> <p><strong>Aims and objectives: </strong>The present study was aimed to determine the relation of the neutrophil-lymphocyte ratio (NLR) and CRP-Albumin ratio (CAR) in early prediction of severity in acute pancreatitis.</p> <p><strong>Materials and methods: </strong>This cross-sectional study was conducted at the Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD), BIRDEM General Hospital, Shahbagh, Dhaka, Bangladesh, from April, 2020 to March, 2022. Diagnosis of acute pancreatitis was made by clinical findings, serum amylase and lipase levels (>3 times the upper limit of normal values), evidences of acute pancreatitis by ultrasonography and computed tomography (CT). Severity of acute pancreatitis was classified according to the revised version of Atlanta classification. Data collection was done through a structured questionnaire. Data were analyzed by SPSS 23. Receiver operating characteristic (ROC) curve was constructed to estimate the sensitivity and specificity of NLR and CAR.</p> <p><strong>Results: </strong>A total of 120 patients with acute pancreatitis were enrolled in this study. Age of the patients was 45.20±13.93 (mean ±SD) years, male predominance was observed (54.2%). Majority of the cases were mild 52.5% (n=63) compared to moderate 28.3% (n=34) and severe 19.2% (n=23). The NLR was 6.63±3.344 (Mean ± SD) with a range of 1.32 to 18.75. The CAR was 3.20±2.23 (Mean ±SD) with range of 0.14-7.20. The area under the curve (AUC) of NLR and CAR were 0.865 and 0.949 for severity of AP respectively. Sensitivity, specificity, PPV, NPV and accuracy of NLR at cut-off ≥5.72 were 80.7%, 76.2%, 75.4%, 81.4% & 78.3% and that of CAR at cut-off ≥2.07 were 96.5%, 76.2%, 78.6%, 96.0% & 85.8%.</p> <p><strong>Conclusion: </strong>This study revealed that NLR and CAR are good predictors in the assessment of severity of AP. These easily accessible and low-cost inflammatory markers can be used for the management of acute pancreatitis.</p> <p>Bangladesh Crit Care J September 2023; 11 (2): 83-89</p>2023-10-04T00:00:00+00:00Copyright (c) 2023 https://www.banglajol.info/index.php/BCCJ/article/view/69181E-Point Septal Separation: A Bedside Tool for Emergency Physician Assessment of Left Ventricular Ejection Fraction2023-10-01T13:25:04+00:00Rownak Jahan Tamannatamannarownak4@gmail.comShabnam Jahan Hoquetamannarownak4@gmail.comFaisal Mohammed Pashatamannarownak4@gmail.com<p><strong>Introduction: </strong>Rapid assessment of left ventricular ejection fraction (LVEF) may be critical among emergency department (ED) patients. This study examined the predictive relationship between bedside mitral-valve E-point septal separation (EPSS) measurements to the quantitative calculated LVEF.</p> <p><strong>Objective: </strong>The aim of this study was to investigate the ability of a new index, namely the mitral valve E-Point Septal Separation (EPSS ) to predict the left ventricular (LV) systolic function.</p> <p><strong>Methods: </strong>A prospective observational study was conducted on a sequential convenience sample of patients, receiving comprehensive Transthoracic Echocardiography (TTE). The current study recruited 100 patients who presented to the Cardiology Clinic of Lab Aid Cardiac Hospital. Echocardiographic examinations were performed to obtain 2D guided M-mode measurements of the EPSS in addition to calculation of conventional, quantitative LVEF. All the measurements were done in the Para-sternal long-axis view. A linear regression analysis was conducted to examine the relation of EPSS to the calculated LVEF from the comprehensive TTE.</p> <p><strong>Results: </strong>Total 100 patients were enrolled in the study. It was found that there was a very significant negative correlation of EPSS with Calculated LVEF (r=--.766, p<0.001). An EPSS ≥ 7 mm was evidence of reduced LVEF <40%, ( p<0.01). Of note an EPSS ≥ 12 mm correlates with severely decreased LV function, with an estimated LVEF of ≤ 30% (p<0.01). As was shown by the results of the linear regression analysis, EPSS was a significant determinant of calculated LVEF (R=.766, p<0.001). The results of the linear regression analysis indicated that the EPSS was an independent predictor of the LVEF.</p> <p><strong>Conclusions: </strong>Measurements of EPSS were significantly associated with the calculated measurements of LVEF from comprehensive TTE. An EPSS measurement of >7 mm was uniformly sensitive at identifying patients with reduced LVEF & >12 mm was uniformly sensitive at identifying patients with severely reduced LVEF. EPSS may allow certain clinicians, especially beginners and emergency department physicians, to assess the LVEF when other methods are not available or questionable.</p> <p>Bangladesh Crit Care J September 2023; 11 (2): 90-94</p>2023-10-04T00:00:00+00:00Copyright (c) 2023 https://www.banglajol.info/index.php/BCCJ/article/view/69194Effectiveness of Plasmapheresis and IVIG in the Treatment of Guillain-Barre Syndrome: A Cross-Sectional Observational Study2023-10-02T11:46:53+00:00Md Hasibuddin Khandrhasibsidrat29@gmail.comMd Khairul Islamdrhasibsidrat29@gmail.comSonia Rahmandrhasibsidrat29@gmail.comAKM Ferdous Rahmandrhasibsidrat29@gmail.comSubroto Kumar Sarkerdrhasibsidrat29@gmail.comMohammad Mohsindrhasibsidrat29@gmail.comMohammad Salimdrhasibsidrat29@gmail.comSardar Mohammad Tanvirdrhasibsidrat29@gmail.comMd Habibullahdrhasibsidrat29@gmail.comMd Mozaffer Hossaindrhasibsidrat29@gmail.com<p><strong>Background: </strong>Plasma exchange and intravenous immunoglobulin (IVIG) are the most effective treatments for Guillain-Barre syndrome; both can improve patients' symptoms. However, limited clinical research is available in Bangladesh to compare the effectiveness of both treatment modalities.</p> <p><strong>Aims: </strong>This study aimed to compare the effectiveness of plasmapheresis and IVIG in the treatment of Guillain Barre Syndrome.</p> <p><strong>Method: </strong>It is a prospective analytical study carried out in the ICU at the Department of Anesthesia, Analgesia, Palliative & Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka, and Transfusion Medicine Department, NINS. Study subjects were patients with GBS, irrespective of gender, race, ethnic group, and age. For this study, they were divided into Group A (treated by IVIG) and Group B (treated by plasmapheresis). The clinical outcome & disability grade were evaluated and compared between groups.</p> <p><strong>Result: </strong>In this study plasmapheresis was associated with more improvement compared to IVIg, moreover there was a significant difference in the disability scores between the two groups after 12 weeks of treatment. Group B with plasmapheresis had a significantly lower mean disability score (1.26 ± 0.06) compared to Group A with IVIg (3.05 ± 0.17) with a p-value of 0.011 At presentation and immediate post-therapy, there was no statistically significant difference between the two treatment groups in terms of MRC grade. However, at the later time points (6 and 12 weeks), Group B (plasmapheresis) was associated with a statistically significant improvement in MRC grade compared to Group A (IVIg). Specifically, at six weeks, the mean MRC grade was 3.18 for Group A and 4.04 for Group B (p=0.038), and at 12 weeks, the mean MRC grade was 3.52 for Group A and 4.87 for Group B (p=0.019). The mechanical ventilation rate was higher in IVIg (51.4% vs 14.2%, respectively) group. The difference was statistically significant (p=0.017). The proportion of individuals with complete recovery was significantly higher in Group B (60%) compared to Group A (22.8%) with an odds ratio of 5.06 (95% CI: 1.79-14.31) and a risk ratio of 1.959 (95% CI: 1.24-3.01). The proportion of individuals with residual deficit was significantly lower in plasmapheresis (25.71%) compared to Group A (57.1%) with an odds ratio of 3.85 (95% CI: 1.40-10.59) and a risk ratio of 2.22 (95% CI: 1.18-4.18), and this was statistically significant. There was no statistically significant difference in the proportion of individuals who died between the two groups, with a p-value of 0.530.</p> <p><strong>Conclusions: </strong>In point of comparison, plasmapheresis has a potential benefit over intravenous immunoglobulin.</p> <p>Bangladesh Crit Care J September 2023; 11 (2): 95-102</p>2023-10-04T00:00:00+00:00Copyright (c) 2023 https://www.banglajol.info/index.php/BCCJ/article/view/69188Study of mortality risk factors and outcomes in COVID-19 patients at a tertiary care hospital in West Bengal, India2023-10-01T14:41:21+00:00Kaushik Ghoshdrkaushikghosh@gmail.comSusmita Ghoshdrkaushikghosh@gmail.comSonali Ghoshdrkaushikghosh@gmail.comAmitava Acharyyadrkaushikghosh@gmail.comUday Sankar Ghoshdrkaushikghosh@gmail.comMohammad Azizur Rahmandrkaushikghosh@gmail.com<p><strong>Background: </strong>The risk of mortality is high in Coronavirus disease-19 (COVID-19)patients. The management of COVID-19 patients may be aided by the identification of variables associated with mortality. The aim of the study was to ascertain the outcomes and mortality risk factors in COVID-19 patients at a tertiary care facility in West Bengal, India.</p> <p><strong>Method: </strong>A total of 94 patients with moderate to severe symptoms of COVID-19 were included in this observational descriptive study from April 2021 to June 2021. The patients with moderate to severe infection diagnosed by Indian Council of Medical Research (ICMR) guidelines admitted to the hospital, and those willing to participate in the study, were included. Those with mild symptoms and who refused to participate were excluded from the study. The severity of patient condition was determined by Ministry of Health & Family Welfare (MoHFW) guidelines. Informed consent has been obtained from patients. Data was analyzed by Microsoft® Excel workbook 2007 into SPSS v 21.0 (IBM, USA).</p> <p><strong>Results: </strong>Fifty-four percent of the patients had moderate, and 45.7% had severe infections. In-hospital mortality was 41.5% among moderate to severe infected COVID 19 positive patients. Non-survivors have significantly higher levels of neutrophils to lymphocyte ratio (NLR), blood urea, and sodium levels in comparison with survivors (P<0.05). On multivariate logistic regression, only the severity of infection (determined by Ministry of Health & Family Welfare guidelines) was an independent predictor of in-hospital mortality (adjusted OR, 3.73; 95% CI, 1.4717 to 9.4616; P=0.005).</p> <p><strong>Conclusion: </strong>COVID-19 patients with severe infection on admission are more likely to die.</p> <p>Bangladesh Crit Care J September 2023; 11 (2): 103-108</p>2023-10-04T00:00:00+00:00Copyright (c) 2023 https://www.banglajol.info/index.php/BCCJ/article/view/69185Premature rupture of membrane - Evaluation of incidence and risk factors in a tertiary Medical College Hospital2023-10-01T13:53:30+00:00Ummul Nusrat Zahandrnusrat77@gmail.comMost Nasrin Niggerdrnusrat77@gmail.comSheuly Akterdrnusrat77@gmail.com<p><strong>Background: </strong>Premature rupture of membrane (PROM) is defined as rupture of membrane before onset of true labour pain and one of the most common complications of pregnancy. It is associated with maternal morbidity and perinatal morbidity and mortality. Objective of this study is to determine the incidence and risk factors of pregnant woman with PROM admitted in a tertiary medical college in Bangladesh.</p> <p><strong>Materials and methods: </strong>This prospective observational study was conducted in the Department of Obstetrics and Gynaecology at Khawaja Younus Ali medical college, Sirajgonj from 1st January 2021 to 31st December 2021. In this period total admitted antenatal patients were 8117. Among the pregnant patients with PROM were 665 and their weeks of gestation were > 28 weeks. Data was collected by an interviewer with semi structured questionnaire & check list.</p> <p><strong>Results: </strong>Incidence of PROM was 9.3%. PROM was found to be frequent (39.1%) in younger age group between 21-25 years. Majority of the patients were housewife (71%). Maximum (61%) patient’s education level was up to secondary. PROM is extremely influenced by low socioeconomic status which was (49.1%) of cases in our study. It was also common in multigravida (67.2%) and term PROM was higher (56.4%) than preterm PROM (43.6%). Analysis of risk factors revealed etiology was unknown in 53 (48%) cases, anemia (16 %), lower genital tract infection (7.2%), UTI (19%), previous history of PROM (26.3%), malpresentation (15%) multiple pregnancy (6.7%) DM and GDM (10.5%) were commonly associated with PROM.</p> <p><strong>Conclusions: </strong>Early identification of various risk factors causing PROM and their management can prevent premature deliveries and its complications to some extent as well as serious maternal complication like Chorioamnionitis.</p> <p>Bangladesh Crit Care J September 2023; 11 (2): 109-112</p>2023-10-04T00:00:00+00:00Copyright (c) 2023 https://www.banglajol.info/index.php/BCCJ/article/view/69183Frequency, Clinical Presentation, and Outcome of Acute-on-Chronic Liver Failure among Decompensated Cirrhosis of Liver Patients in a Tertiary Care Hospital2023-10-01T13:31:37+00:00Md Abu Sayeed Mustafadrgolamazam@gmail.comMd. Golam Azamdrgolamazam@gmail.comSaker Mohammed Sajjaddrgolamazam@gmail.comSafikul Islamdrgolamazam@gmail.comRiad Mohammad Moshaed Hossaindrgolamazam@gmail.comIndrajit Kumar Dattadrgolamazam@gmail.comA H M Rowshondrgolamazam@gmail.com<p><strong>Background: </strong>Acute-on-chronic liver failure (ACLF) is characterised by the presence of organ failure in patients with decompensated cirrhosis and is associated with high short-term mortality. Different international entities have taken initiatives to define the condition in different times but recommendations and definitions from The European Association for the Study of the Liver- Chronic Liver Failure (EASL-CLIF) Consortium Acute-on-Chronic Liver Failure in Cirrhosis (CANONIC) study are most comprehensive and widely accepted till date. Only limited data are available on the prevalence, clinical characteristics, and short-term outcomes of ACLF in Bangladesh. It would be very useful for clinicians to identify patients with ACLF early and initiate focused therapy including referral to transplant centers if these data are available.</p> <p><strong>Objective: </strong>To evaluate frequency, clinical presentation, and outcome of acute-on-chronic liver failure among decompensated cirrhosis of liver patients.</p> <p><strong>Materials and Methods: </strong>This prospective observational study was carried out at the Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD), BIRDEM General Hospital, Shahbagh, Dhaka, Bangladesh from July, 2019 to September, 2021. Total 175 patients with decompensated cirrhosis of liver were screened, out of which 22 patients were dropped out due to various reasons. Purposive type of non-probability sampling technique was used. Formal ethical clearance was taken from the Institutional Review Board and ethical measures were ensured in concordance with the Declaration of Helsinki. An informed written consent was taken from all participants. Diagnosis of decompensated cirrhosis was based on clinical, biochemical, radiological and endoscopic findings. Laboratory data sent within 24 hours were collected. Oxygen saturation was measured using fingertip pulse oximeter. Investigations for ACLF triggers were done as necessary which included but not limited to urine routine and microscopic examination, urine culture, blood culture, and Anti HEV IgM. Patients’ prognosis and survivability were observed by follow up phone call at 30 days. All data were recorded in a separate case record form and finally, it was analyzed by SPSS 23.</p> <p><strong>Results: </strong>Out of 153 patients, 49 patients (32%) had ACLF: grade 1 ACLF in 26 (17%), grade 2 in 18 (11.8%), and grade 3 in 5 (3.3%) patients. Patients had an average age of 59.54±11.55 years with no significant difference between ACLF and no ACLF groups. Most patients in both groups had others (NAFLD, autoimmune hepatitis, secondary biliary cirrhosis, idiopathic) as the main underlying cause of cirrhosis. Bacterial infection, GI bleeding, HEV infection, reactivation of HBV were the precipitating events in 81.6% of patients with ACLF, with bacterial infection being the most common trigger (63.3%). Overall, 44.9% ACLF patients died within 30 days of admission. Older age, male sex, hepatic encephalopathy, GI bleeding, presence of any trigger and higher Child-Turcotte-Pugh (CTP) score were associated with increased risk of death in ACLF.</p> <p><strong>Conclusion: </strong>Follow up of 153 patients with decompensated cirrhosis of liver revealed that 1 in 3 patients had ACLF and 44% of them would die in 30 days. Bacterial infection and GI bleeding were the most common triggers of ACLF. Early identification and intervention with multidisciplinary approach and referral to transplant centers are likely to improve survival outcomes in this population.</p> <p>Bangladesh Crit Care J September 2023; 11 (2): 113-120</p>2023-10-04T00:00:00+00:00Copyright (c) 2023 https://www.banglajol.info/index.php/BCCJ/article/view/69184Palliative care in ICU: Scope and Limitations that ICU physicians need to know2023-10-01T13:35:55+00:00Mehnaz Ferdousmehnazmdccm@gmail.comMohammad Omar Faruqmehnazmdccm@gmail.com<p>Abstract not available</p> <p>Bangladesh Crit Care J September 2023; 11 (2): 66-67</p>2023-10-04T00:00:00+00:00Copyright (c) 2023 https://www.banglajol.info/index.php/BCCJ/article/view/69189Treatment of Thyroid Storm in ICU2023-10-01T14:43:36+00:00SM Ashrafuzzamanashrafzaman1961@gmail.com<p>Among endocrine emergencies thyroid storm is a very devastating disease. Sometimes patient presents with cardiovascular or neurological disorder, admits in general medical unit other than ICU. But all Thyroid storm patients should be treated in medical ICU. Delay in diagnosis and/or treatment increases morbidity and mortality. Presentation usually with severe hyperthyroid with other systemic dysfunction. Liver function test usually altered. It has got definite diagnostic criteria. Burch HB, Wartofsky L has a scoring scale. Temperature, involvement of central nervous system, Gastro-intestinal or Liver, Heart rate, Atrial fibrillation and precipitating factors give definite scoring system and ideas for prognosis. Treatments depend on severity and associated co-morbidities. Propylthiouracil or Carbimazole or Methimazole should be started early. Propranolol/beta blocker, Digoxin, Saturated Solutions of Potassium Iodide, Hydrocortisone, Antibiotics and IV fluids are essential. Rarely treated with Cholestyramine, Lithium etc. Plasmapheresis is a lifesaving procedure.</p> <p>Bangladesh Crit Care J September 2023; 11 (2): 121-126</p>2023-10-04T00:00:00+00:00Copyright (c) 2023 https://www.banglajol.info/index.php/BCCJ/article/view/69150A case report on Port-a-Cath related bacteremia with Pantoea species in a cancer patient2023-09-30T04:48:21+00:00Rinki Kundukundurinki88@gmail.comNajeeb Mahiyuddinkundurinki88@gmail.comRajib Bhadrakundurinki88@gmail.comAfsana Begumkundurinki88@gmail.com<p>Pantoea species are gram negative rods that rarely effects human. They usually cause infection in immunocompromised hosts. The cause is usually due to trauma by vegetative material or contamination of medical devices. Here we report a case of bacteremia due to Pantoea species in patient with malignancy having a Port-a-Cath. The infection was detected by blood culture from both chemo port and peripheral line. The clinical outcome was good with intravenous antibiotics and chemo port removal.</p> <p>Bangladesh Crit Care J September 2023; 11 (2): 127-129</p>2023-10-04T00:00:00+00:00Copyright (c) 2023 https://www.banglajol.info/index.php/BCCJ/article/view/69195Two Cases of Hypokalaemic Periodic Paralysis due to Conn’s Syndrome2023-10-02T11:46:18+00:00Md Imdadul Hoque Chowdhuryimdad010790@gmail.comMostofa Monwar Kowshikimdad010790@gmail.comPartha Pratim Dasimdad010790@gmail.comMuhammad Habibul Hasan Souravimdad010790@gmail.comSorowar Hossenimdad010790@gmail.comMd Kamal Uddinimdad010790@gmail.comAKM Ferdous Rahmanimdad010790@gmail.comMohammad Mohsinimdad010790@gmail.comSubroto Kumar Sarkerimdad010790@gmail.comMohammad Salimimdad010790@gmail.com<p>Aldosterone producing adenoma, also known as Conn’s syndrome, is the most common secondary form of hypertension. Conn’s syndrome is characterized by hypertension with increased aldosterone, low renin, hypernatremia and hypokalaemia. Clinical manifestations include hypertension in young or resistant hypertension, generalized weakness and fatigue. Here we report two cases presenting with hypokalaemic periodic paralysis and ultimately diagnosed as primary hyperaldosteronism due to Conn’s syndrome.</p> <p>Bangladesh Crit Care J September 2023; 11 (2): 130-132</p>2023-10-04T00:00:00+00:00Copyright (c) 2023 https://www.banglajol.info/index.php/BCCJ/article/view/69180Does risperidone causes life threatening pancytopenia? A case report from Nepal2023-10-01T12:21:33+00:00Bikash Khadkakhadka.vkas@gmail.comKishor Khanalkhadka.vkas@gmail.comKrishna Bhusalkhadka.vkas@gmail.comSandip Raj Pradhankhadka.vkas@gmail.comSabina Shahkhadka.vkas@gmail.comKailash Khatrikhadka.vkas@gmail.comSaroj Poudelkhadka.vkas@gmail.com<p>Antipsychotic drugs like risperidone are sometimes associated with rare but serious adverse events such as pancytopenia. We describe a 38-year-old man on risperidone for schizophrenia for two months who experienced pancytopenia. There was no prior history of hematological diseases or contact with possible triggers in the patient. Upon admission, he presented with symptoms of generalized weakness, black stool, constipation, and recurrent urinary tract infection. Risperidone was promptly discontinued, and supportive measures including prophylactic antibiotics, blood transfusion, and colony-stimulating factors were initiated. Close hematological monitoring should be considered in patients on risperidone, and awareness of the potential risk of pancytopenia associated with its usage is crucial. Timely identification and management of drug-induced pancytopenia are crucial to ensure favorable patient outcomes and prevent potentially life-threatening complications.</p> <p>Bangladesh Crit Care J September 2023; 11 (2): 133-136</p>2023-10-04T00:00:00+00:00Copyright (c) 2023 https://www.banglajol.info/index.php/BCCJ/article/view/69161A Case Study on Pemphigus Vulgaris2023-09-30T10:48:33+00:00Rabita Nur Mannanrabitanur18@gmail.comAfsana Chowdhuryrabitanur18@gmail.comAfia Mahmuda Khanrabitanur18@gmail.comFannana Nowshinrabitanur18@gmail.comMd Tarek Alamrabitanur18@gmail.com<p>Pemphigus vulgaris is a chronic autoimmune mucocutaneous disease that is primitively demonstrated in the form of intraoral lesions extending to other mucous membranes and the skin. The origin of pemphigus vulgaris is unknown, even though the disease has prompted considerable interest. It is marked by the existence of circulating IgG antibodies directed against desmosomes, which are skin components that retain particular layers of skin bound to one another. When desmosomes are attacked, the skin layer separates, and the clinical presentation resembles a blister. Oral lesions are vesiculobullous at first but easily rupture, with new bullae attempting to form as the older one’s rupture and ulcerate. A biopsy of perilesional tissue and histological and immunostaining examination is required for a correct diagnosis. The current standard of treatment relies mainly on systemic immunosuppression with corticosteroids, azathioprine, or other adjuvants, but newer therapies with possibly fewer adverse effects also seem promising.</p> <p>Bangladesh Crit Care J September 2023; 11 (2): 137-139</p>2023-10-04T00:00:00+00:00Copyright (c) 2023 https://www.banglajol.info/index.php/BCCJ/article/view/69149A case of reversible cytotoxic lesion of corpus callosum (CLOCCs) secondary to septic encephalopathy caused by suspected enteric fever2023-09-30T04:36:57+00:00Tamanna Yasmin Shenashenayasmin@gmail.comUmme Kulsum Chyshenayasmin@gmail.comAmina Sultanashenayasmin@gmail.comMohammad Omar Faruqshenayasmin@gmail.com<p>Abstract not available</p> <p>Bangladesh Crit Care J September 2023; 11 (2): 140-141</p>2023-10-04T00:00:00+00:00Copyright (c) 2023 https://www.banglajol.info/index.php/BCCJ/article/view/69179Cutaneous Anthrax2023-10-01T11:59:29+00:00Md Habibullahr.fuad59dmc@gmail.comMahbuba Khan Eusuf Zair.fuad59dmc@gmail.comMohammad Abu Hanifr.fuad59dmc@gmail.comSardar Mohammad Tanvirr.fuad59dmc@gmail.com<p>Abstract not available</p> <p>Bangladesh Crit Care J September 2023; 11 (2): 142-143</p>2023-10-04T00:00:00+00:00Copyright (c) 2023