The Stability and Suitability of the Bhasan Char Island as an Accommodation for the Forcibly Displaced Myanmar Nationals (FDMN)

Assessing the dynamics of Bhasan Char is very crucial, as the Government of Bangladesh (GoB) has recently selected the island as the accommodation of the FDMN. This article critically evaluates the spatiotemporal morphological variations due to erosion, accretion, and subsurface deformation of the island through multi-temporal geospatial and geophysical data analysis, groundwater quality-quantity, and also determines the nature and rate of changes from 2003 to 2020. This is the first study in this island on which multi-temporal Landsat Satellite Imagery and seismic data have been used with geospatial techniques with Digital Shoreline Analysis System (DSAS) and petrel platform, respectively. The analysis of satellite images suggests that the island first appeared in 2003 in the Bay of Bengal, then progressively evolved to the present stable condition. Significant changes have taken place in the morphological and geographical conditions of the island since its inception. Since 2012, the island has been constantly accreted by insignificant erosion. It receives tidally influenced fluvial sediments from the Ganges-Brahmaputra-Meghna (GBM) river system and the sedimentary accretion, in this case, is higher than the erosion due to relatively weaker wave action and longshore currents. It has gained approximately 68 km2 area, mostly in the northern part and because of erosion in the south. Although the migration of the Bhasan Char was ubiquitous during 2003–2012, it has been concentrated in a small area to the east since 2018. The net shoreline movements (NSM) suggest that the length of the shoreline enlarged significantly by around 39 km in 2020 from its first appearance. Seismic and GPS data clearly indicate that the island is located on the crest of a slowly uplifting low-amplitude anticline, which may result in a stable landform around the island. Based on the analysis of historical data, it has been assessed that the current configuration of Bhasan Char would not be severely affected by 10–15-foot-high cyclone. Therefore, FDMN rehabilitation here might be safer that would be a good example for future geo-environmental assessment for any areas around the world for rehabilitation of human in remote and vulnerable island. The findings of this research will facilitate the government’s decision to rehabilitate FDMN refugees to the island and also contribute to future research in this area.

Fulminant Myocarditis Following COVID-19 Vaccination: A Case Report

Background The BNT162b2 vaccine received emergency use authorization from the U.S. Food and Drug Administration for the prevention of severe COVID-19 infection. We report a case of biopsy and MRI-proven severe myocarditis that developed in a previously healthy individual within days of receiving the first dose of the BNT162b2 COVID-19 vaccine. Case Summary An 80-year-old female with no significant cardiac history presented with cardiogenic shock and biopsy-proven fulminant myocarditis within 12 days of receiving the BNT162b2 COVID-19 vaccine. She required temporary mechanical circulatory support, inotropic agents and high-dose steroids for stabilization and management. Ultimately her cardiac function recovered, and she was discharged in stable condition after 2 weeks of hospitalization. A repeat cardiac MRI 3 months after her initial presentation demonstrated stable biventricular function and continued improvement in myocardial inflammation. Discussion Fulminant myocarditis is a rare complication of vaccination. Clinicians should stay vigilant to recognize this rare, but potentially deadly complication. Due to the high morbidity and mortality associated with COVID-19 infection, the clinical benefits of the BNT162b2 vaccine greatly outweighs the risks of complications.

Acute HBV Related ALF- Successful Outcome with Oral Antiviral Treatment

Case report: We present a young female of fourteen years who was admitted to the hospital with short duration of Icterus, malaise, vomiting and diagnosed to be having acute hepatitis B. She went into acute liver failure as evidenced by development of hepatic encephalopathy and coagulopathy. She was managed on lines of hepatic encephalopathy along with oral antiviral treatment. She recovered successfully and was discharged after two weeks in heamodynamically stable condition. After a gap of six months, she became Hepatitis B surface (HbsAg) & hepatitis B e-antigen (HbeAg) negative and Hepatitis B Virus DNA (HBV DNA) was undetectable with normal liver function tests. She is on regular follow up for last one year and is absolutely normal. Conclusion: Acute hepatitis B can go into acute liver failure in 1% of cases, treatment for which includes liver transplantation and oral antiviral treatment which is especially helpful in cases who cannot afford liver transplantation, as was in our case.

Conjunctivitis

Conjunctivitis represents an inflammation of conjunctiva with cellular infiltration, exudation, and vascular dilation. According to the course of the disease, conjunctivitis can be acute, hyperacute, and chronic. Morphologically, conjunctivitis can appear with papillary reaction, follicular reaction, cicatrizing, granulomatous and membranous changes. This chapter discusses all types of conjunctivitis, their clinical signs and symptoms, and basic approaches of treatment. This chapter includes before and after treatment photos of atypical inferiorly localized shield ulcer, Tularemia-associated Parinaud oculoglandular syndrome, and Stevens-Johnson disease. Pictures are included In the ligneous conjunctivitis patient's case taken at diagnosis as well as 10 years later, demonstrating stable condition with appropriate treatment throughout the period.

Rapid Bedside Ultrasound Evaluation of a Ruptured Abdominal Aortic Aneurysm With a Prior Repair

ABSTRACT Ruptured aortic aneurysms carry a high risk of morbidity and mortality, particularly if not rapidly identified. We present an 87-year-old male, with a history of hypertension and prior endovascular aortic repair, who presented to the Emergency Department (ED) with several days of epigastric abdominal pain radiating to his back and flanks. The patient acutely deteriorated in the ED, and point-of-care ultrasound rapidly identified active extravasation from an abdominal aortic aneurysm with visualization of prior endograft. Point-of-care ultrasound in this patient expedited the diagnosis, resuscitation, and transfer to the operating room with definitive repair by vascular surgery. The patient recovered and was discharged in stable condition.

Systolic and Diastolic Inter-Arm Blood Pressure Difference: A Cross-Sectional Study Of 3030 Young Healthy Adults

More than 100 years ago, the difference in blood pressure (BP) between arms was first reported. Recent studies have shown that different blood pressure between the right and left arm leads to cardiovascular events. Three thousand and thirty volunteers participated in our study. The sIABP was equal in 163 of 3030 persons (5.37%), dIABP was equal in 222 out of 3030 persons (7.32%), from a total of 792/3030 persons (26.1%) sIAD > 10 mmHg, and dIAD > or =10 mmHg was found in 927 out of 3030 persons (33.5%) in the right arm, and 32.4% in the left arm. In 2692 of 3030 volunteers BP, initially recorded in the dominant hand (right arm), showing sIAD> or = 10 mmHg was found in 943 (37.1%) volunteers, and when the first measurement was done in 338 left-handed volunteers it showed sIAD> or = 10 mmHg in 112 of 338 (34.1%), P < 0.001; 95% confidence interval for systolic right hand were (115.73: 116.73), and for systolic left hand 95% confidence interval were (113.17:114.15). Furthermore, height, residential area, and heart rate above 90 bpm had a significant effect on IAD (P =. 041, .002, <001, respectively). In conclusions significant inter-arm systolic and diastolic BP differences above (10 mm Hg) is common in the young, healthy population. Hand dominance is a significant consideration while measuring blood pressure. It is mandatory to measure blood pressure in both arms in a sitting position with a stable condition.

Gambaran Keseimbangan Pada Pasien Post Stroke Setelah Pemberian Latihan Berbasis Virtual Reality: Literature Review

Post-stroke is a condition where the stroke patient has gone through an emergency so that he is in a stable condition. Post-stroke patients can experience various functional limitations, one of which is balance disorders. Patients experiencing this type of disorder can be given balance exercises based on virtual reality. Virtual reality will provide visual, proprioceptive, and auditory stimulation trough computer hardware and software to engage in artificial environments that appear and feel similar to real world objects and events. This study aimed to describe balance of post-stroke patients after being given virtual reality-based exercises. The method used in this study was a literature review analysis with the PICO method. Five articles were obtained to be reviewed from several data bases such as PubMed (n=2) and Google Scholar (n=3). The results of the analysis of the five articles showed that the average age of the respondents was > 60 years; 51.7% were female and 48.3% were male; and the average value of pre-test as well as post-test were 42.1 and 47.2 with an increase of 5.1. In conclusion, there was an increase in the balance of post-stroke patients after undergoing virtual reality-based exercises with significant results. . Therefore, researchers or practitioners are suggested to develop a Virtual Reality method on balance disorders in post-stroke patients in the form of treatment and subsequent research.Keywords: Balance; Post Stroke; Virtual Reality AbstrakPost stroke merupakan kondisi dimana pasien stroke telah melalui keadaan darurat sehingga pasien dalam keadaan stabil. Pasien post stroke dapat mengalami berbagai keterbatasan fungsional salah satunya gangguan keseimbangan yang dapat diberikan latihan keseimbangan berbasis Virtual Reality. Virtual Reality akan memberikan stimulasi visual, proprioseptif, dan pendengaran melalui perangkat keras dan perangkat lunak komputer untuk terlibat dalam lingkungan buatan yang muncul dan terasa mirip dengan objek dan peristiwa dunia nyata. Peneltian ini bertujuan untuk mengetahui gambaran keseimbangan pada pasien post stroke setelah pemberian latihan berbasis Virtual Reality. Metode yang digunakan dalam penelitian ini yaitu analisis literature review dengan metode PICO, didapatkan lima artikel untuk direview dari beberapa data base seperti PubMed (n=2) dan Google Scholar (n=3). Hasil analisis lima artikel didapatkan responden rata-rata usia > 60 tahun dan jenis kelamin perempuan 51,7% dan laki-laki 48,3%, nilai rata-rata pre test dan post test 42,1 dan 47,2 dengan peningkatan sebesar 5,1. Kesimpulannya didapatkan gambaran adanya peningkatan keseimbangan pasien post stroke setelah pemberian latihan berbasis Virtual Reality dengan hasil yang signifikan. Saran untuk peneliti atau praktisi bisa mengembangkan metode Virtual Reality pada gangguan keseimbangan pasien post stroke dalam bentuk treatmen dan penelitian berikutnya.Kata kunci: Keseimbangan; Post Stroke; Virtual Reality

Polymyxin B infusion related respiratory arrest: A case report

A 73 years old male, known hypertensive on medication, with the history of SARS-CoV-2 infection nine months ago, presented to us with mucormycosis, he was treated with Liposomal amphotericin B initially. He developed acute kidney injury with recurrent pulmonary oedema requiring ICU admission and Haemodialysis. He later developed catheter related blood stream infection that grew Carbapenem resistant Klebsiella pneumonia and was started on Polymyxin B. However from day 3 of antibiotics he started to develop recurrent respiratory arrest with no apparent cause. He required a brief period of mechanical ventilation and was successfully weaned. He had recurrent such episodes with no apparent cause. After extensive work up and literature search it was diagnosed as Polymyxin B induced respiratory failure. Polymyxins were stopped, patient was discharged in a stable condition after five days of further observation and is currently on follow up with no such episode of dyspnoea.

ECAST Syndrome (Exercise Collapse Associated with Sickle Cell Trait): First Knock of Sickle Cell in a Young Bodybuilder

ECAST Or exercise collapse associated with sickle cell trait is a rare phenomenon associated with sickle cell trait and is an important presentation of sickle cell disease in sports medicine. Collapse is seen following vigorous physical activity, which is due to excessive heat, dehydration and other factors associated with physical exercise. This rare syndrome is often missed by the treating physicians as a result of a lack of knowledge about this rare entity leading to massive underreporting. It is important to identify ECAST as a cause of the collapse in young athletes to prevent mortality and morbidity and in order to provide prompt treatment. We report a case of a 25- year-old young male who was a bodybuilder and reported to the gym after a one-year-long break due to lockdown restrictions of COVID19. After a vigorous exercise session, he collapsed in the gym and was brought to the emergency department. After proper history taking and examination, he was suspected to be a case of ECAST due to a history of a similar episode three years back which was treated as a case of exertional syncope with intravenous fluid therapy and a family history of Sickle cell trait with his mother and father both having sickle cell AS Pattern. Ultimately our patient turned out to be a case of Sickle Cell Trait with evidence of AS pattern on Hb electrophoresis and a small-sized spleen visualized on CT Scan of the abdomen. The patient was managed successfully with intravenous fluids and blood transfusion and was discharged in a stable condition. He was counseled about moderating his exercise and is doing well on follow-up.

Justification of treatment and possible outcomes of severe COVID-19

The role of hyaluronic acid in the pathogenesis of acute respiratory distress syndrome, including those associated with severe COVID-19, is known. Pro-inflammatory cytokines (interleukin-1, tumor necrosis factor) are strong inducers of hyaluronic acid synthase (HAS2) in CD31+ endothelial cells, EpCAM+ cells of the alveolar epithelium of the lungs and fibroblasts. Hyaluronic acid can absorb water in quantities significantly exceeding its own molecular weight. Reducing the presence or inhibiting of hyaluronic acid synthesis is of great importance for facilitating the breathing of COVID-19 patients. Hyaluronidase-based preparations can reduce the accumulation of hyaluronic acid and promote pulmonary alveoli cleansing. Respiratory viral infections, including pandemic strains of coronaviruses, especially in severe cases with acute respiratory distress syndrome, can be complicated by the development of pulmonary fibrosis. It has been shown that changes in X-ray Computed Tomography findings characteristic of fibrosis in the first year after COVID-19 can significantly regress. A clinical case from the practice of treating a patient with a severe course of COVID-19, significant cardiovascular comorbidity, grade 2 obesity, which was regarded as significant risk factors for an unfavorable outcome, is presented. The patient with signs of progressive respiratory failure was admitted to the intensive care unit. Pulse therapy with glucocorticosteroids and anticoagulants was started. Deterioration of the condition is regarded as the beginning of acute respiratory distress syndrome, which complicated the cytokine storm induced by the coronavirus. The patient was taken for high-flow oxygenation. An anti-cytokine therapy was prescribed. Reduction of inflammatory markers was obtained, but severe respiratory failure persisted. The bovgialuronidase azoximer was included in the treatment. The patient's condition began to stabilize then she was discharged in stable condition without oxygen support. The available data on the negative role of hyaluronic acid in the pathogenesis of acute respiratory distress syndrome in patients with COVID-19, as well as the need to reduce the likelihood of developing residual fibrous changes in the lungs in patients who have undergone acute respiratory distress syndrome, suggest the need for further studies of domestic azoximer bovgialuronidase properties in the treatment of severe forms of COVID-19.