Variceal Hemorrhage: Decompression, Obliteration, or Both?

Variceal hemorrhage is a morbid condition that frequently mandates the involvement of interventional radiology to achieve successful and sustained hemostasis. Primary image-guided therapies for variceal hemorrhage include a transjugular intrahepatic portosystemic shunt and transvenous obliteration. Knowledge of variceal pathophysiology and anatomy, current techniques, and the evidence supporting therapeutic selection is paramount to successful patient outcomes. The purpose of this review is to provide the reader a framework of the available literature on image-guided management of bleeding varices to assist in clinical management.

STUDY OF DEMOGRAPHIC ANALYSIS, CLINICAL CHARACTERISTICS, DIAGNOSIS, MANAGEMENT AND COMPLICATIONS IN COVID-19 PATIENTS

Objective: To study the demographic analysis, clinical characteristics, diagnosis, and management in covid-19 patients. To assess the complications in covid-19 patients. Methods: A retrospective observational single centered study is carried out to study the demographic analysis, clinical characteristics, diagnosis, management, and complications in covid-19 patients. Results: Among 100 covid-19 patients 58% were male and 42% were female. Percentages of age group between 60-70 years (27%), 50-60 (20%), 40-50 (16%), 70-80 (16%), 30-40 (8%), 20-30 (5%), 80-90 (4%), and 10-20 (4%). Co-morbidities were diabetes (44%), hypertension (28%), CAD (21%), thyroid (19%), COPD (12%), anemia (8%), and renal impairment (4%). Signs and symptoms were fever (88%), cough (80%), SOB (72%), fatigue (68%), myalgia (60%), loss of appetite (52%), cold (24%), loss of smell and taste (20%), diarrhea and vomiting (12%). (97%) of the patients had two or more symptoms. Diagnostic test include RT-PCR (100%), HRCT (100%), O2 saturation (99%), D-dimer (65%), c-reactive (60%), Procalcitonin (60%), and also LDH, IL-6,PT, INR, ferritin, CBP, WBC. Treatment includes antiviral (100%), antibiotics (100%), corticosteroids (73%), immunosuppressant (54%), and antihypertensive, antidiabetic, Antiplatelets, bronchodilators, vitamins, and mineral supplements. Conclusion: Covid-19 infects the males more and average ages of 65 years are at risk. Hypertension and diabetes were most common co-morbid condition. Fever and cough are major followed by weakness sob and cold. RT- PCR and HRCT are accurate tool to detect covid-19. Although standard treatment is not yet available antibiotics and antiviral are used followed by corticosteroids. Majority of the patients have mild and moderate injection and with the lowest death rate. Older age and co-morbid conditions are major risk factors.

A 26-Year-Old Woman with Bronchial Asthma and COVID -19 Treated by Stand Alone Siddha Medicine: A Case Report

Background: Corona virus disease 2019 (COVID-19) is a public health emergency of international concern. The global population lacks immunity to COVID-19 and is generally susceptible. Underlying conditions, especially chronic respiratory diseases, may affect progression, treatment and prognosis of COVID-19. The majority of people who exposed to COVID-19 suffer only mild respiratory symptoms like cough, cold, difficulty in breathing, etc and these symptoms were correlated with Kaba Suram in the Siddha literature. Case Summary: Siddha Clinical Research Unit, New Delhi (CCRS), Ministry of AYUSH, Govt. of India had reported a patient with confirmed COVID-19 by RT-PCR with bronchial asthma as a co-morbid condition. Recovery time from disease onset to negative test for COVID-19 was 19 days. Conclusion: Since the patient residing in Dwaraka, New Delhi has bronchial asthma as a co-morbid condition, both air pollution and the winter season are likely to increase the severity of the disease. But it was observed that the patient’s condition did not deteriorate, so it could be presumed that the management of COVID-19 with the given Siddha internal medicines and external therapies as a standalone treatment ceased the progress of the disease to a severe stage. Key words: Bronchial Asthma, Corona virus, COVID-19, Kaba Suram, Siddha Medicine.

Profile of Herpes Zoster Patients with Co-morbidities: Cross-sectional Observation at a Tertiary Level Hospital in Dhaka

Introduction: Herpes zoster (HZ) is characterized by an extremely painful vesicular rash, which may be complicated by secondary infection and post-herpetic neuralgia. To date, multiple risk factors associated with HZ have been established, including endocrine diseases, immunosuppressive conditions, cancers, and other chronic medical conditions. Objectives: To assess the profile of herpes zoster associated with co-morbid condition. Methods and Materials: This cross sectional study was conducted among purposively selected 130 HZ patients in the department of Dermatology and Venereology, Combined Military Hospital (CMH) Dhaka from January 2017 to December 2018. Data were collected through face to face interview using pretested semi-structured questionnaire. Results: Out of 130 patients, majority of the patients were male (69.2%) and mean age was 53.5±9.8 years and majority gave the history of chicken pox 60% and common site of involvement were chest (right and left) 33.1% and 48.5%, upper back (right and left) 30.8% and 43.1% and upper right arm 33.1%. About 66.9% patients gave the history of having co-morbid condition like Diabetes 30.8%, Stroke 9.2%, Hypertension 2.3%, Myocardial infarction 3.8%, Peptic ulcer disease 10.0%, Malignancy 2.3%, Tuberculosis 2.3% and Irritable bowel syndrome 2.3%. Conclusion: Based on our study finding, we can conclude that herpes zoster is a disease that is associated with other co-morbid conditions. If herpes zoster is an early manifestation of undiagnosed co-morbid condition, patients should undergo testing for undiagnosed disease when they present with herpes zoster. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 40-43

Effectiveness of Bypass and Sleeve Bariatric Surgical Methods in Weight Reduction

Obesity is a chronic disease described by the large amount of body fat that leads to an increase in Body Mass Index (BMI). It is subdivided into three levels, being grade I with a BMI between 30 and 34.9 kg/m2, grade II between 35 and 39.9 kg/m2 and grade III or morbid obesity with a BMI above 40 kg/m2. Aiming at reversing the morbid condition caused by the disease, the bariatric surgical technique presents itself as the most effective option to contain grade III obesity, as well as the associated co morbidities. The objective of surgical techniques is to improve the quality of life of the obese, reducing both physical and psychosocial problems. As endocrine disease is related to several co morbidities, such as high blood pressure, sleep apnea and even some types of cancer, it is necessary to carry out an investigation into the surgical technique to be applied as well as its effectiveness during and after the surgical procedure.

Morbidity Management and Disability Prevention of Lymphatic Filariasis

Lymphatic Filariasis (LF) vector-borne, chronically disabling parasitic contamination inflicting elephantiasis, lymphoedema, and hydrocele, is a leading public strength convenience as nicely as serious socioeconomic trouble due to its morbid condition, social stigma, and massive financial loss in many creating nations, and this sickness has been ranked as the second primary purpose of long-term continual incapacity worldwide. World Health Assembly decision in 1997 for Eliminate of Lymphatic Filariasis (ELF) via 2020 made all the filaria endemic nations in the world put efforts for its removing with the aid of regularly decreasing and finally interrupting the transmission of Lymphatic Filariasis (LF). Another lookup is wished to aid efforts to ‘scale-up morbidity manipulation and incapacity alleviation programs at the countrywide stage and to report the extent to which anti-filarial drug cure influences the direction of filariasis associated disorder.

HOLISTIC APPROACH OF AYURVEDA IN THE MANAGEMENT OF EKA-KUSHTHA W. S. R. TO PSORIASIS - A CASE STUDY

Skin is the largest organ which reflects the both healthy and diseased condition of the body. According to ancient Ayurved samhitas, all the skin diseases are categorized under Kushtha roga. In modern world, skin has greater cosmetic importance leading to boost the confidence and personality of an individual as well as to attain the healthy mindset. The morbid condition of the skin should be treated earlier as it may attain Krichrasadhya or even Asadhya avastha also. Ancient Acharyas have been explained in detail the Panchakarma accompanying with variety of Shamana aushadhis and Sthanika chikitsa to treat the Kushtha rogas. In the present case study, a 37 years old female patient having symptoms resembling to Eka kushtha was treated with combine use of ancient Ayurvedic treatment protocols viz., Nidana parivarjana, Shodhana chikitsa, Shamana aushadhis and Sthanika chikitsa together with Pathyapathya. The assessment of Lakshanas was done by using WHO guidelines for Kushtha. This comprehensive approach of Ayurveda to treat the Eka kushtha helps to achieve the significant relief in symptoms of the patient.

Technological Resources for Fighting COVID-19 Pandemic Health Issues

The COVID-19 pandemic has had a global effect with several people dying daily due to the dreaded disease. Therefore, each individual has a duty to support the efforts of their countries either financially, socially, technically, or by any other means to contribute to the fight against the COVID-19 pandemic. During this crisis, engineers can come up with innovations to fight the pandemic. One of the reasons for the death of a patient suffering from COVID-19 was the lack of resources required for patient care. The doctors who are taking care of COVID patients could get infected due to lack or the deficiency of available safety kits. Some of the resources required to fight COVID-19 are personal protective equipment (PPE) (e.g. gloves, gowns, face masks and shields for respiratory and eye protection respectively), mechanical ventilators and body vital monitoring devices. Engineers can contribute to the fight against COVID-19, by developing compact size ventilators, 3D printed face shield, masks, door handles, hand sanitizer, etc. The available medicines to fight the disease are still under development and trials with limited options at present has led to deaths among patients mostly those who are elderly or having any co-morbid condition. The deficiency of medicine availability can be resolved up to some extent by applying tools of supply chain management.

Surgical Management of Necrotizing Pancreatitis

Pancreatic necrosis is a highly morbid condition. It is most commonly associated with severe, acute pancreatitis, but can also be caused by trauma or chronic pancreatitis. Once diagnosed, management of pancreatic necrosis begins with supportive care, with an emphasis on early, and preferably, enteral nutrition. Intervention for necrosis, sterile or infected, is dictated by patient symptoms and response to conservative management. When possible, intervention should be delayed to allow the necrotic collection to form a capsule. First-line treatment for necrosis is with percutaneous drainage or endoscopic, transmural drainage. These strategies can be effective as monotherapy, but the need for repeated interventions, or for progression to more invasive interventions, is not uncommon. Necrosectomy may be performed using a previously established drainage tract, as in percutaneous endoscopic necrosectomy (PEN), video-assisted retroperitoneal debridement (VARD), and direct endoscopic necrosectomy (DEN). Although outcomes for these minimally-invasive techniques are better than for traditional necrosectomy, both laparoscopic and open techniques remain important for patients with extensive disease that cannot otherwise be adequately treated. This is especially true when pancreatic necrosis is complicated by disconnected pancreatic duct syndrome (DPDS), where necrosectomy remains standard of care.

Letter to the Editor in response to ‘Parental attachment and depressive symptoms in pregnancies complicated by twin-twin transfusion syndrome: a cohort study’

Twin-twin transfusion syndrome is a highly morbid condition that can affect parental attachment and depression risk. Studies addressing this rare condition are hard to conduct and thus lacking in the literature. In this letter to the editor, we acknowledge the article of Mackie et al. entitled “Parental attachment and depressive symptoms in pregnancies complicated by twin-twin transfusion syndrome: a cohort study” to be of high importance and impact, but would like to discuss the extent of its conclusions, and push towards bigger studies in this field.