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Bangladesh Critical Care Journal
Number of Followers: 1

This is an Open Access Journal

Open Access journal
ISSN (Print) 2304-0009 - ISSN (Online) 2304-0009
Published by Bangladesh Journals Online

[88 journals]

Delirium in ICU patients: A syndrome ICU staff better not miss
- Authors: Amina Sultana, Mohammad Omar Faruq
  Pages: 7 - 9
  Abstract: Abstract not available Bangladesh Crit Care J March 2022; 10 (1): 7-9
  PubDate: 2022-04-25
  DOI: 10.3329/bccj.v10i1.59196
  Issue No: Vol. 10, No. 1 (2022)
Role of Glucose Variability in the Diagnosis of Septic Patients
- Authors: Muhammad Asaduzzaman, Md Nasir Uddin Ahmed, AKM Ferdous Rahman, Syed Tariq Reza, Mayisha Afifa, BUM Wahid Ahmed, Mohammad Asaduzzaman
  Pages: 10 - 14
  Abstract: Background: Glucose variability is an indicator and independent predictors of mortality and severity of sepsis in critically septic patients of intensive care unit. Objectives: This study evaluated the relationship of glucose variability in critically ill septic patients in relation with serum lactate. Method: It is a prospective observational study was conducted in the Intensive Care Unit (ICU) in Department of Anesthesia, Pain, Palliative Care and Intensive Care, Dhaka Medical College hospital, Dhaka over a period of one year in between 1st January- 31st December, 2015. Total 51 septic adult patients were included in the study according to the selection criteria. In this study, 8 consecutive capillary blood samples were taken with a periodic interval of 3 hours starting from admission. Mean and standard deviation (SD) blood glucose were computed to see the glucose variability and agreement done with serum lactate and severity of sepsis. All collected data were registered documented and analyzed in the statistical program Statistical Package for Social Science (SPSS) version 20.0. Result: Among total 51 patients, 52.9% study cases were of 4th decade with a mean age of 46±12 years had a mild female predominance. Glycemic variability was taken as >2SD. High glycemic variability observed in 70.6% cases. Good agreement observed in glucose variability with serum lactate by Kappa Statistics. Conclusion: Glucose variability shows the prediction of sepsis and it could be used as a useful alternative tool to predict sepsis and severity of sepsis. Bangladesh Crit Care J March 2022; 10 (1): 10-14
  PubDate: 2022-04-25
  DOI: 10.3329/bccj.v10i1.59197
  Issue No: Vol. 10, No. 1 (2022)
Hospital Outcome of Acute Stroke Patients Associated with Various Risk
Factors and Co-morbidities
- Authors: Mohammed Salah Uddin, AM Kamrul Hasan, Ratan Das Gupta, Rajan Mondal, Shamanta Faria
  Pages: 15 - 18
  Abstract: Background: Stroke is a global health problem, leading cause of death all over the world. It accounts for chronic illness and disability in a large segment of population. It imposes a great loss on economy of the nation due to loss of service of the workforce during illness and extended hospitalization they require during recovery. Stroke continues to have a great impact on public health. It is associated with multiple risk factors and co-morbid conditions. Objective: To find out the hospital outcome of acute stroke patients associated with various risk factors and co-morbidities. Materials and methods: This is a cross sectional observational study, carried out in the department of Medicine and Neurology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh for a period of 6 months. One hundred patients presented with acute stroke diagnosed on clinical & investigational background fulfilling the inclusion and exclusion criteria were enrolled in the study. Stroke severity was assessed using National Institute of Health Stroke Scale (NIHSS) score. Patients’ symptoms, degree of disability or dependence in the daily activities and clinical outcome were evaluated and measured by the modified Rankin Scale (mRS). Result: This study showed that a majority of patients (49%) were in the 51-60 years age group, mean age was 56.81 years. Male and female ratio was 1.38:1. Among all all-risk factors, hypertension is the most common, present in 72% cases; the next most common risk factors were DM (59%), smoking (47%), heart disease (35%), and migraine (14%). About 72% of patients had a mild stroke, 17% of patients had a moderate stroke and 11% of patients had a severe stroke according to NIHSS score at admission. Seventy-four (74%) of them had infarction and the rest had hemorrhage. The study showed that 62% of the patients recovered (mRS score 0 to 2) and among them the maximum were ischemic stroke. 29% had poor outcomes, disabled and they were discharged on request or risk bond (mRS score 3 to 5). 9% expired during hospital stay (mRS score 6). Logistic analysis revealed that age >50 years, hypertension, diabetes mellitus, heart disease, hyperlipidemia, family history of CVD, CAD, past history of stroke / TIA, migraine and peripheral vascular disease were associated with poor stroke outcome. Conclusion: This study shows that the main risk factors & the comorbid conditions for a stroke were hypertension, diabetes mellitus, ischemic heart disease, hyperlipidemia and smoking. People suffering from a stroke with these risk factors have poorer outcomes than those with no risk factors & comorbidities. Identifying characteristics of people at high risk of recurrence has important implications for planning secondary prevention strategies to reduce the disease burden. Early detection and prevention of the risk factors can reduce health care burden and disability. Bangladesh Crit Care J March 2022; 10 (1): 15-18
  PubDate: 2022-04-25
  DOI: 10.3329/bccj.v10i1.59198
  Issue No: Vol. 10, No. 1 (2022)
Evaluation of the Causes of Resistant Hypertension in Non-dialysis Chronic
Kidney Disease Patients
- Authors: Md Enamul Haque, Khan Md Nazmus Saqeb
  Pages: 19 - 25
  Abstract: Background: In Chronic Kidney disease (CKD), resistant hypertension (RH) is a common condition due to a combination of factors including sodium retention, increased activity of the renin-angiotensin system, and enhanced activity of the sympathetic nervous system. The aim of the study was to determine the causes of resistant hypertension in non-dialysis Chronic Kidney Disease Patients. Methods: This descriptive cross-sectional study was conducted in the department of Nephrology & Internal Medicine of Dhaka Medical College Hospital from 18th January 2016 to 20th may 2016. Patients aged above 18 years admitted with resistant RH and CKD were enrolled in the study after fulfilling the inclusion and exclusion criteria. The study involved 50 CKD patients who had RH. Purposive consecutive type of sampling technique was applied for sample collection. Detail socio-demographic data were collected and recorded in a predesigned questionnaire. Clinical examination and relevant investigations were done. Data was analysed with SPSS version 22.0. P value of <0.05 was considered significant. Result: Maximum number of patients 23(46.0%) were between 46-60 years age group, mean age of the patient was 53.17 ± 8.42 years. Male: female ratio was 1.63:1. Study showed that frequency of RH and CKD gradually increased with age. In case of both sexes, 46-60 years age group showed the highest incidence for CKD. The mean systolic and diastolic blood pressures (BP) were 133.04 ± 12.91 mmHg and 81.07 ± 6.41 mmHg respectively. Those with diabetes mellitus, obesity (BMI > 27.5 kg/m2) and those who were older than 55 years were significantly higher in the RHT group than in the non-RHT group. Conclusion: RH in CKD patients was significantly associated with the presence of obesity, diabetes mellitus and increased age. These factors should always be kept in mind while treating HTN in CKD patients. Bangladesh Crit Care J March 2022; 10 (1): 19-25
  PubDate: 2022-04-25
  DOI: 10.3329/bccj.v10i1.59199
  Issue No: Vol. 10, No. 1 (2022)
Outcome of Transcutaneous Electrical Nerve Stimulation (TENS) device for
patients with chronic non-specific low back pain
- Authors: Naima Siddiquee, Fauzia Sobhan, Fatema Newaz, Hasna Raihan Rahim, Tanzina Akhter, Zafar Sadeque
  Pages: 26 - 32
  Abstract: Background : Transcutaneous electrical nerve stimulation (TENS) was introduced more than 30 years ago as an adjunct to the pharmacological management of pain. Objective : This controlled trial examined the benefit of TENS on patients with chronic non-specific low back pain. Methods : This randomized controlled clinical trial was conducted in the department of Physical Medicine and Rehabilitation of Bangabandhu Sheikh Mujib Medical University, Dhaka over a period of 6 months from March,2013 to August,2013. One hundred and ten (n=110) participants were treated. 55 patients were treated with NSAID+ADL, consider as Group-A (treatment as usual control group) and 55 patients were treated with NSAID+ADL+TENS, consider as Group-B (experimental group). Result : The mean age was found 39.1 ± 1.34 years in Group-A and 41.3 ± 2.80 years in Group-B.. Mean duration of pain was found 23.20 ± 2.34 months in Group-A and 21.00 ± 1.50 months in Group-B. Subjective pain intensity, Visual analogue score, tenderness index improved in both groups after at the end of 3rd week and at the end of 6th week, which was statistically significant but in between two groups there is no statistically significant difference. Conclusion :These results suggested that TENS specifically could not have an effect in reducing pain and improving quality of life in chronic non specific low back pain patients but as number of patients were small no firm conclusion could be drawn. Bangladesh Crit Care J March 2022; 10 (1): 26-32
  PubDate: 2022-04-25
  DOI: 10.3329/bccj.v10i1.59200
  Issue No: Vol. 10, No. 1 (2022)
Management of adult diabetic patients of Bell’s palsy with and without
steroid: experience from a tertiary care hospital
- Authors: Dilruba Alam, Md Rashedul Islam, Rumana Habib, Mohammad Sakhawat Hossen Khan, Rushda Sharmin Binte Rouf
  Pages: 33 - 37
  Abstract: Background: Bell's palsy is the most common cause of lower motor neuron type facial nerve palsy and one of the most frequently encountered presentations in Department of Neurology. Initial treatment involves oral corticosteroids, possible antiviral drugs, protection of the eye from desiccation and physiotherapy. But in case of patients with Bell's palsy and diabetes mellitus (DM) decision of prescribing steroid is a major concern due to risk of hyperglycaemia and still a point of conflict. Aim of this study is to observe the outcome of diabetic patients with Bell's palsy with and without steroid therapy. Methods: This retrospective study was conducted from January 2017 to December 2020, in Department of Neurology of BIRDEM General Hospital, Shahbag, Dhaka, Bangladesh. During this period 50 adult diabetic patients with Bell's palsy were recruited retrospectively from hospital records according to inclusion criteria and divided into two groups depending upon the duration of symptoms and prescribing steroid. Group I consisted of patients with Bell's palsy who attended after 72 hours of onset of symptoms and was not prescribed steroid or antiviral drugs, whereas Group II included patients attending within 72 hours of onset of symptoms and received steroid and antiviral drugs. House-Brackmann (H-B) Grading system was used to assess the severity of facial dysfunction. Patients of Grade III and above were recruited in this study and during follow up Grade I and II were considered as recovered. All participants of Group II received prednisolone in divided doses of up to 60 mg for 5 days and then tapered over next 5 days along with the antiviral agents. Patients in the Group I were given supportive care. All patients of both the groups received physiotherapy for facial asymmetry and medication for eye care along with close monitoring and management of diabetes and other comorbidities. H-B Grades at onset, after 10 days, at the end of 1st and at 3rd month after facial paralysis were assessed. Recovery time and the number of patients who demonstrated improvement were compared between the groups. Results: Total 50 adult diabetic patients with Bell's palsy were included. Mean age at presentation was 48.5 ± 13.6 years, 44% were male and 56% female. Hypertension (HTN) was present in 50% cases. A total of 30 patients (60%) received oral steroid with anti-viral drugs and 20 (40%) received only supportive treatment. Significant statistical difference was observed with regard to H-B Grades, recovery time and number of patients between steroid group (Group II) in comparison to patients of non-steroid group (Group I) after 10 days (p 0.007), at 1st month ( p <0.001) and at 3rd months (p <0.001) after facial paralysis. Among comorbidities HTN (p 0.021), Glycated haemoglobin (HbA1c) (p 0.033) and High density lipoprotein (HDL) (p 0.005) contributed to the outcome. Conclusion: From the present study it is observed that patients with DM with Bell's palsy, the recovery of facial functions may be satisfactory with steroid therapy. Bangladesh Crit Care J March 2022; 10 (1): 33-37
  PubDate: 2022-04-25
  DOI: 10.3329/bccj.v10i1.59201
  Issue No: Vol. 10, No. 1 (2022)
Procalcitonin: A unique marker to evaluate the severity of sepsis among
diabetic patients
- Authors: Mohammad Moniruzzaman, Mousumi Karmaker, Sadia Tasnim, Saimun Nahar Rumana, Jasmin Nur, AA Mamun Sarker, Zeenat F Rahman, Md Sohrab Alam, Mansura Khan
  Pages: 38 - 42
  Abstract: Introduction: Diabetes mellitus (DM) is considered one of the largest emerging threats to health and bacterial infections are more frequent in diabetic patients causing sepsis. Several indicators have been proposed as new diagnostic tests to assess sepsis in hospitalized patients. Aim: This study aims was to compare the efficacy of Procalcitonin (PCT) and high sensitive C-reactive protein (hs-CRP) in the diagnosis of sepsis in diabetic patients. Methods: In this cross-sectional study total of 60 age and sex-matched diabetic patients above 18 years were randomly chosen with at least 2 SIRS (Systemic inflammatory response syndrome) criteria from the indoor department of BIRDEM General Hospital. Basic hematological, biochemical, microbiological laboratory data were recorded from laboratory reports. Sepsis and its different stages were determined according to American College of Chest Physicians (ACCP) guidelines. The PCT was measured by sandwich enzyme immunoassay (Bio-Vendor, Germany) and the hs-CRP level was measured using an immune-turbidimetric assay (Beckman, Carlsbad, CA 92010, USA). Results: The patient’s mean age was 51.90±9.89 years where male 51.2% and female 48.8% and 50-60 years age group was the most common 40%. 38 (63.33%) patients were bacteriological culture-positive and 22 (36.67%) patients were bacteriological culture-negative where the most common organism was Klebsiella (28.95%). Statistically, a significant difference was found in PCT values in the bacteriological culture positive and negative group (p<0.05), but there was no significant difference found in hs-CRP values (p>0.05). There was an increasing trend of serum PCT with the developing stages of sepsis. Receiver operating characteristic curve shows the area under the curve for PCT was 0.785 (95% CI; 0.654-0.915), sensitivity 89.47%, specificity 50%, PPV 75.55% and NPV 73.33% with the best cut-off value >753pg/ml which support PCT as a superior and reliable marker of sepsis. Conclusion: Our results suggest that serum PCT is a more reliable diagnostic marker of sepsis than other traditional markers like hs-CRP. Combinatorial use of these biomarkers will help in early diagnosis and also greatly improve outcomes. Bangladesh Crit Care J March 2022; 10 (1): 38-42
  PubDate: 2022-04-25
  DOI: 10.3329/bccj.v10i1.59202
  Issue No: Vol. 10, No. 1 (2022)
Frequency and Outcome of Ventilator Associated Pneumonia in an Intensive
Care Unit of a Tertiary Care Hospital in Dhaka
- Authors: Tasmia kashfi, ASM Areef Ahsan, Rozina Sultana
  Pages: 43 - 47
  Abstract: Background: Intubation and mechanical ventilation are integral parts of critical care management. Though a lifesaving intervention, invasive mechanical ventilation imposes a great risk of nosocomial pneumonia to the patient. Ventilator associated pneumonia rates in an ICU is a predictor of successful infection control strategy. Objectives: objective of the current study was to study the frequency of ventilator associated pneumonia and its outcome in the critical care setting. Methods: This prospective observational cross-sectional study was done in department of critical care medicine of BIRDEM General Hospital for the period of 1st July, 2017 to 30th June, 2018. All consecutive patients who were intubated and mechanically ventilated for a period of at least 48 hours within the study period were evaluated for the selection criteria of the study. The included study participants were followed up daily for signs of development of VAP. Once VAP was suspected pertinent investigations were sent to confirm the diagnosis. Study participants were observed regularly to identify signs of pulmonary infection. The microbiological tests were done in the Department of Microbiology of BIRDEM. Quantitative culture was done (expressed as CFU/ml) and antibiotic sensitivity was done by standard disc diffusion method. A cutoff value of 105 CFU/ml was taken as a positive culture. CPIS score was calculated to diagnose VAP .The study participants were followed up to transfer to step down unit/ward or death to see the outcome. Data were collected in preformed data collection sheet and analyzed by the statistical packages for social sciences (SPSS) software version 22. Results: In this study total 92 patients out of 625 intubated patients during the study period after fulfilling the inclusion criteria were selected as study participants. The mean age of the the participants who developed VAP was 65.05±14.79 years with a range of 27 to 101 years. 62.9% (n=22) were female and 37.1% (n=13) were male. In this study DM, HTN & Renal disease were the most common co-morbidities. Among the 35 VAP positive participants 51.4% (n=18) developed early onset VAP and 48.6% (n=17) developed late onset VAP. Among the VAP positive participants 31.4% were survivors and 68.6% were non-survivors and among the VAP negative participants 68.4% were survivors and 31.6% were non survivors (p=0.001). Conclusion: Frequency of VAP was 5.6% in the study. It was associated with significantly prolonged length of mechanical ventilation and length of ICU stay and high mortality. Bangladesh Crit Care J March 2022; 10 (1): 43-47
  PubDate: 2022-04-25
  DOI: 10.3329/bccj.v10i1.59203
  Issue No: Vol. 10, No. 1 (2022)
Combining Telbivudine with Tenofovir in hepatitis B virus related acute on
chronic liver failure reduce the risk of renal impairment.
- Authors: Abul Hayat Manik, Debraj Malakar, Tania Islam Resma, Kaniz Fatema Ananya, Shameem Al Mamun, Salimur Rahman
  Pages: 48 - 51
  Abstract: Introduction: Chronic hepatitis B virus (HBV) infection is a major health problem because of its worldwide distribution and its potential adverse sequel, including acute-on-chronic liver failure (ACLF), liver cirrhosis and hepatocellular carcinoma. Short term prognosis of patients with spontaneous severe acute exacerbation of CHB leading to ACLF- like presentation is extremely poor, with mortality ranging from 30% to 70%. Therefore, early and rapid reduction of HBV DNA is the essence of therapy in ACLF-B. Methods: Patients with spontaneous reactivation of HBV [(ALT >5 × upper limit of normal or >2 × baseline) and HBV DNA >20,000 IU/ml] were randomized to Tenofovir mono therapy (300 mg/day) or Tenofovir plus Telbivudine (600 mg/day) dual therapy along with standard medical treatment. Clinical and biochemical parameters were evaluated at baseline, 1 week, 4 weeks and at 3 months. Virological evaluation was done at baseline and at 3 months. Primary end point was reduction of HBV DNA. Secondary end point was reduction of liver related complication, therapy related adverse effects and survival at 3 months. Results: 27 patients were enrolled and 15 of them received mono therapy with Tenofovir and 12 patients received dual therapy (Tenofovir plus Telbivudine). Baseline parameters in two groups had no significant difference. Both groups significantly improve s. bilirubin, ALT, INR, CTP score and MELD score. Only MELD score showed significant improvement in patient with dual therapy at 3 months in comparison of mono therapy. 11 patient on Tenofovir mono therapy (n=15) showed undetected HBV DNA (91.7%) at 3 month and one patient had detectable HBV DNA (<2,000 IU/ml). 10 patients on dual therapy (n=12) had undetectable HBV DNA (100%). Patients receiving dual therapy showed significant improvement in AKI on follow up compared to those on Tenofovir mono therapy. Among 5 deaths, 3 had received mono therapy with Tenofovir and 2 had received dual therapy. Predictors of mortality were high S. bilirubin (25.8±7.8), HBV DNA (5.18±1.17 log10 IU/ml), MELD score (33.0±4.2) and CTP score (12.2±0.8). Conclusion: In spontaneous reactivation of hepatitis B presenting as acute on chronic liver failure, combination of Telbivudine plus Tenofovir is potentially safer with less risk of Tenofovir related nephrotoxicity and hence improved outcomes. Bangladesh Crit Care J March 2022; 10 (1): 48-51
  PubDate: 2022-04-25
  DOI: 10.3329/bccj.v10i1.59204
  Issue No: Vol. 10, No. 1 (2022)
Endotracheal intubation using video laryngoscopy causes less
cardiovascular response and less airway morbidity compared to classic
direct laryngoscopy during surgery.direct laryngoscopy during surgery
- Authors: Niaz Ahmed, AM Kamrul Hasan, Mohammed Salah Uddin, Md Junayed Imam Bhuiyan, Md Zishan Uddin, Kazi Muhammed Mahmudul Hasan, Md Abdulah Al Mahammud Kabir
  Pages: 52 - 56
  Abstract: Introduction: Endotracheal intubation using video laryngoscopy causes less cardiovascular response and less airway morbidity compared to classic direct laryngoscopy, in cardiac surgery. A comparison of the cardiovascular responses to endotracheal intubation using both indirect video laryngoscopy and direct laryngoscopy within the same patient has not yet been described. Materials and methods: This comparative randomized controlled clinical trial on 110 patients undergoing elective CABG. Data were expressed as mean ± SD and statistically analyzed using analysis of variance (ANOVA) and paired “t”-test over time and software SPSS-19.00. Results: Total intubation time was significantly higher in Video laryngoscopy group than direct laryngoscopy group (Table 2). The mean effective airway time were 6.15±4.92 in Video laryngoscopy group and 11.32(±9.11) in direct laryngoscopy group which was statistically significant (Table 3). The relative increase of the Rate Pressure Product (RPP) at intubation was significantly smaller (i.e. 27%, P < 0.001) using video laryngoscopy compared to the classic direct laryngoscopy. Cardiovascular responses were blunted by an additional 10. 2% (P = 0.029), when the patient was on beta blockade (Table 4). Conclusion: Study observed that less hemodynamic responses during endotracheal intubation using indirect video laryngoscopy compared to classic direct laryngoscopy. Even if the patient is on beta-blocker therapy, diminished cardiovascular responses at intubation were recorded after indirect laryngoscopy compared to direct laryngoscopy. Bangladesh Crit Care J March 2022; 10 (1): 52-56
  PubDate: 2022-04-25
  DOI: 10.3329/bccj.v10i1.59205
  Issue No: Vol. 10, No. 1 (2022)
Correlation of Ultrasonographically Measured Splenic Size with Endoscopic
Grading of Esophageal Varices in Cirrhosis of Liver
- Authors: Shamanta Faria, Mashah Binte Amin, Mohammed Salah Uddin, Tarana Yasmin, Kaniza Kobir Shanta, Khalada Parvin Deepa, Hiijul Bahar
  Pages: 57 - 61
  Abstract: Background: Cirrhosis is the end stage of chronic liver disease, resulting in formation of fibrous tissue, derangement of liver architecture and ultimately results in portal hypertension and its complication. Objective: To find out the correlation between splenic size and endoscopic grading of esophageal varices in diagnosed cases of cirrhosis of liver. Methods: This prospective observational cross-sectional study was carried out in the Department of Radiology and Imaging in collaboration with GHPD, BIRDEM, Dhaka. 110 liver cirrhosis patients with or without esophageal varices diagnosed by endoscopy of UGIT referred to the department of Radiology and Imaging were included in this study on the basis of selection criteria. Result: The following observations and results were obtained in this study the mean age was 44.81 (±14.42) years, minimum age was 18 years and maximum age was 65 years. Majority 69% were male and 31% were female. Esophageal variceal grading of the study population majority 47(42.73%) were grade I, 24(21.82%) were grade II, 16(14.55%) were grade III, 12(10.91%) were grade IV and 11(10%) were no varices. Splenic size by ultrasonography, majority 66(60%) were 12-14.9 cm, 37(33.64%) were ≥15 cm and 07(6.36%) were < 12 cm. In splenic size ≤ 15 cm, grading of esophageal varices, 15.07% had no varices, 60.27% had grade I, 20.55% had grade II, 2.74% had grade III and 1.37% had grade IV. In splenic size ≥ 15 cm grading of esophageal varices, 8.11% had grade I, 24.32% had grade II, 37.84% had grade III and 29.73% had grade IV. That means there is a positive correlation between ultrasonographically measured splenic size and endoscopic grading of esophageal varices in liver cirrhosis patients. Conclusion: Positive correlation was found between ultrasonographically measured splenic size with endoscopic grading of esophageal varices. Bangladesh Crit Care J March 2022; 10 (1): 57-61
  PubDate: 2022-04-25
  DOI: 10.3329/bccj.v10i1.59206
  Issue No: Vol. 10, No. 1 (2022)
Tissue plasminogen activator (tPA) treatment for COVID 19 associated
respiratory failure: A case Series
- Authors: Md Motiul Islam, Muhammad Mazharul Hoque, Tarikul Hamid, Muhammad Rabiul Halim, Kazi Nuruddin Ahmed, Rajib Hasan
  Pages: 62 - 67
  Abstract: The global pandemic of COVID-19 has oversaturated the medical care facilities with a large proportion of patient associated with acute respiratory distress syndrome (ARDS). ARDS in patients with COVID-19 is associated with high incidence of pulmonary embolism, pulmonary hypertension and microthrombotic complications. Although heparin is frequently used to treat thrombotic pathology COVID-19, pulmonary embolism is still observed in severe cases. Pathology reports consistently demonstrate diffuse pulmonary microthrombi on autopsy, consistent with vascular occlusive etiology of respiratory failure rather than the more classic finding in ARDS. Pulmonary microthrombi induced respiratory failure is very difficult to prove because the patients are so critically ill that transfer to CT suit to do CT pulmonary angiogram (CTPA) often become unsafe for the patients. Moreover, performing V/Q scan is increasingly difficult in these settings. Here we report a case series of 10 patients with severe COVID-19 associated respiratory failure who were treated with tissue plasminogen activator (tPA). Bangladesh Crit Care J March 2022; 10 (1): 62-67
  PubDate: 2022-04-25
  DOI: 10.3329/bccj.v10i1.59207
  Issue No: Vol. 10, No. 1 (2022)
Gastroduodenal intussusception caused by a prolapsing gastric polyp in a
65 year old lady.
- Authors: Khan Md Nazmus Saqeb
  Pages: 68 - 70
  Abstract: Gastroduodenal intussusception caused by a gastric polypoid mass is a very rare cause of gastric outlet obstruction.We report a rare case of a 65 year old lady who presented with a 6 months history of postprandial abdominal discomfort with recurrent vomiting and a 5 kg of weight loss during the last 5 months period. After several investigations a tubulovillous adenoma with a long pedicle arising from the gastric wall of upper body was found to be prolapsing into the duodenum through the pylorus producing gastroduodenal intussusception and thus giving rise to features of gastric outlet obstruction. Although gastroduodenal intussusception caused by a gastric polypoid mass is a very rare cause of gastric outlet obstruction, it should be kept in mind as one of the differentials. Bangladesh Crit Care J March 2022; 10 (1): 68-70
  PubDate: 2022-04-25
  DOI: 10.3329/bccj.v10i1.59208
  Issue No: Vol. 10, No. 1 (2022)
Acute hemolytic anaemia following naphthalene poisoning in a G6PD
deficient patient
- Authors: Tamanna Yasmin Shena, Umme Kulsum Chy, Amina Sultana, Mohammad Omar Faruq
  Pages: 71 - 74
  Abstract: Naphthalene is a widely used industrial and household chemical in the form of mothballs. They are potentially hazardous and rare agents of poisoning. We present a case of ingestional naphthalene poisoning in a G6PD deficient 20 years old male patient with a good outcome after proper management. He presented with abdominal pain, vomiting, fever, passage of dark cola colored urine and jaundice after deliberate ingestion of few mothballs. Features of severe intravascular hemolysis with methemoglobinemia were detected. His G6PD activity was found below normal and was diagnosed as G6PD deficiency disorder. He was treated with IV saline infusion, multiple blood transfusions, IV ascorbic acid and N-acetyl cysteine. He was discharged after 10 days of hospital stay with full recovery. Bangladesh Crit Care J March 2022; 10 (1): 71-74
  PubDate: 2022-04-25
  DOI: 10.3329/bccj.v10i1.59209
  Issue No: Vol. 10, No. 1 (2022)
Accidental Carbon monoxide poisoning with Neurological Sequelae
- Authors: Md Mazharul Hoque, Md Motiul islam, Tarikul Hamid, Mohammad Rabiul Halim, Kazi Nuruddin Ahmed, Rajib Hasan, Md Atiquzzaman, Rahatul Jannat Nishat
  Pages: 75 - 77
  Abstract: Carbon monoxide (CO) intoxication is one of the leading causes of accidental poisonings1. It often leads to diagnostic errors, because of its presenting symptoms are extremely nonspecific and confounding. Symptoms commonly include headache, dizziness, weakness, vomiting, chest pain and confusion. Large exposures can result in loss of consciousness, arrhythmias, seizures, or death. The most common location of exposures causing CO poisoning are in homes and less commonly in workplaces 2. Unintentional, non-fire related CO poisoning is responsible for approximately 450 deaths and 21,000 emergency department (ED) visits each year in United States3,4,5. Bangladesh Crit Care J March 2022; 10 (1): 75-77
  PubDate: 2022-04-25
  DOI: 10.3329/bccj.v10i1.59210
  Issue No: Vol. 10, No. 1 (2022)
A case of Appendicitis on contrast CT abdomen
- Authors: Umme Kulsum Chy, Amina Sultana, Mohammad Omar Faruq
  Pages: 78 - 79
  Abstract: Abstract not available Bangladesh Crit Care J March 2022; 10 (1): 78-79
  PubDate: 2022-04-25
  DOI: 10.3329/bccj.v10i1.59211
  Issue No: Vol. 10, No. 1 (2022)