Effect of low dose Methotrexate in newly diagnosed Rheumatoid arthritis case

Rheumatoid arthritis is a painful debilitating joint disease with the proliferation of the synovium and progressive erosion of cartilage and bone. Methotrexate (MTX) has been used for the treatment of Rheumatoid Arthritis (RA) for about 3 decades. It is most effective and commonly used Disease Modifying Antirheumatic Drugs (DMARDS) because it improves symptoms, signs, disease activity and functions. This study was done from January 2016 to December 2016 for a period of 1 year under Physical Medicine and Rehabilitation department, Jalalabad Ragib-Rabeya Medical College (JRRMC), Sylhet. Here we treated the patients with low dose methotrexate. Study was done to see the effect of low dose MTX in newly diagnosed RA patients by clinical examination and DAS 28. DAS stands for disease activity score and 28 joints that are examined in this assessment. The result concluded low dose MTX improves the symptoms, signs, disease activity and functions of the patients. Bangladesh Crit Care J March 2021; 9(1): 34-37

Potential long term adverse health outcomes of COVID-19

The coronavirus disease 2019(COVID-19) pandemic poses an extraordinary challenges to patients, communities and overall health care systems. It has resulted in millions of people infected worldwide and has indirectly devastated even more individuals with prolonged post-infectious symptoms. The burden of survivors having post-COVID symptoms is likely to be huge. Multidisciplinary post-COVID-19 clinics are now playing a pivotal role addressing both persistent symptoms and potential long term sequelae. In this review, we tried to summarize the adverse health outcomes based on current evidences, assess the potential risk of long-term complications and make certain recommendations. Bangladesh Crit Care J March 2021; 9(1): 38-40

Evaluation of Percutaneous tube Thoracostomy Performed by Trainee in both Trauma and non-Trauma Patients

Background: Percutaneous Tube Thoracostomy (PTT) is an invasive procedure that can save life now and then in different traumatic and non-traumatic conditions. But still it is an enigma; how our trainee surgeons are at home in this procedure. Objectives: To evaluate the outcome of the percutaneous tube thoracostomy performed by trainee in both trauma and non-trauma patients. Study design: Prospective, Observational study. Duration of study was September, 2019 to February, 2019. Methods: All patients who need PTT in traumatic and non-traumatic conditions were selected by purposive sampling. Thereafter, they were scrutinized according to eligibility criteria and 96 patients were finalized. A pre-tested, observation based, peer-reviewed data collection sheet was prepared before study. Data regarding clinical and surgical outcome profile were recorded. Data were compiled, edited, analyzed. Results: Among 96 patients, the highest 32.29% belonged to age group 31-40 years and lowest 9.37% belonged to age group ≤20. The mean age of the respondents was 29.19±9.81. We found out of 96 patients, 70(72.91%) were indicated PTT for traumatic conditions and rest 26(27.08%) were indicated PTT for non-traumatic chest condition where 36(37.5%) had simple penumothorax, 21(21.87%) haemothorax, 14(14.58%) massive pleural effusion, 13(13.54%) tension pneumothorax, 10(10.41%) haemopneumothorax, and 2(2.08%) had pyothorax respectively. In 53.12% patients had right sided intercostal chest tube (ICT) insertion whereas 46.87% had left sided ICT insertion. In our study, 89.55 % tube was placed at normal anatomical position. Besides, 10.41% tube thoracostomy were performed deviated from anatomical site. Among 96 patients 62.5% patients had length of incision 2-3cm, 35.41% had >3cm and 2.08% had <2cm respectively. Out of 96 patients 75(78.13%) showed uneventful outcome whereas 21(21.87%) had complications including 11.15%(11) each had wound infection, 4.46%(4) subcutaneous emphysema, 4.28%(3) drain auto expulsion, 2.85%(2) hemorrhage, 1.45%(1) had non-functioning drain and empyema with ascending infection respectively (p=<0.05). Conclusion: PTT is a life saving procedure that is most frequently implemented in chest trauma patients of our country. In majority cases, outcome of PTT were uneventful (78.13). Besides this more than one third of patient had length of incision more than 3 cm that needed extra stitches and 10.41% cases PTT were placed other than the normal anatomical site. Trainees of Dhaka Medical College Hospital are doing well in their performance of PTT insertion but still some anatomical orientations are necessary to avoid operative and post-operative complications Bangladesh Crit Care J March 2021; 9(1): 28-33

Laparoscopic Cholecystectomy in a patient with Situs Inversus Totalis

There are diagnostic and therapeutic challenges in cases of symptomatic gall bladder disease in patients with situs inversus totalis (SIT), where there is complete reversal of visceral topography in thorax, abdomen or both. The difficulty to treat these patients with conventional laparoscopic cholecystectomy may be more pronounced for right handed surgeon and requires modifications in working ports and their positions. We present a case of laparoscopic cholecystectomy in a patient with SIT, and describe the technical details that enable the safe conclusion of the operation. Bangladesh Crit Care J March 2021; 9(1): 43-45

Polyarteritis Nodosa Presenting as Hypertensive Crisis

Hypertensive crisis is a deadly complication that should be avoided at all costs, let alone when it is associated with a rare disease, such as Polyarteritis Nodosa (PAN). We present a case of an adult female who initially came to Bangladesh Medical College Hospital (BMCH) with a prolonged high-grade fever responding to antipyretics. Upon follow up, the patient went into a hypertensive crisis, which led to the admission to Coronary Care Unit (CCU). The hypertension was difficult to control until the culprit was revealed. Polyarteritis Nodosa was then diagnosed by angiography, which showed tight stenosis of the left renal artery. Prompt treatment was initiated, and the patient's blood pressure normalized. Our case highlights the importance of detecting such diseases, since it may be easily missed as it usually presents with nonspecific symptoms. Newly detected Hypertension in patients of any age should not be taken lightly and should be investigated promptly. We hope our case report sheds enough light on this issue for other clinicians and researches to identify and prevent later on. Bangladesh Crit Care J March 2021; 9(1): 52-55

A Survey of Mechanical Ventilation Weaning Practices in ICUs of Bangladesh

Objective : To determine mechanical ventilation discontinuation (weaning) practices in Bangladesh as there is currently no data available on this issue. Method : Analyzing the Survey on Bangladeshi respondents using questionnaire developed by and used by a pan Asian study where Bangladesh critical care physicians participated. Result : 40 physicians from 10 ICUs of Bangladesh participated. Majority of our participating doctors (62.5%) came from private for profit hospital. 19 out of 40 respondents were certified in critical care medicine. In our study spontaneous breathing trial (SBT) was liberally used with pressure support being used by 30% respondents. Most of the extubation trial took place during day. As criteria for extubation, respondents mainly considered consciousness and cooperation and along with gag reflex, cough strength, suction frequency and cuff leak at different times. Noninvasive ventilation (NIV) was commonly used for early extubation in cases of COPD, cardiogenic pulmonary edema, neuromuscular disorders, post-operative cases and obesity. Slightly less than half of respondents did not follow any sedation protocol and 42.5% followed weaning protocol. Protocolized weaning by nurses are not known to be practiced in Bangladesh. Conclusion : Weaning practices are diverse in Bangladeshi ICUs. Protoclized weaning is rarely practiced in Bangladesh. Bangladesh Crit Care J March 2021; 9(1): 4-11

Separating wheat from Chaff: A dilemma for Intensivists in the age of Pandemics!!

not available Bangladesh Crit Care J March 2021; 9(1): 1-3

Fractured intubating stylet: A case of airway foreign body in Intensive care Unit

not available Bangladesh Crit Care J March 2021; 9(1): 41-42

Serum Procalcitonin in the Prediction of Severity and Outcome of Acute Pancreatitis

Background: Different modalities are available for predicting severity and outcome of acute pancreatitis. A single marker with high sensitivity and specificity is yet to be identified. Aim: This study intends to find out the utility of serum procalcitonin in predicting the severity and outcome of acute pancreatitis. Methods: 117 patients admitted with acute pancreatitis were included.Clinical parameters and biochemical tests were recorded on admission, on day-3 & day-5 of admission. CT scan was performed in all patients. Serum procalcitonin was done on admission. Multifactorial scores were calculated using these data.Every patient was followed for identification of organ failure or other complications. Statistical analysis was done with SPSS. Result: Among 117 patients, 67(57.3%) were male. Biliary, hypertriglyceridemia, alcohol, malignancy and post-ERCP complications were found as aetiology in 25(21.4%), 23(19.7%), 8(6.8%), 3(2.6%),2(1.7%) cases respectively. In 53(45.3%) cases no definite etiology could be found. 83(70.9%) patients had mild,15(12.8%) had moderately severe and 19(16.2%) had severe acute pancreatitis. 23(19.65%) patients developed complication, whereas 94 (80.34%) developed none. The mean serum procalcitonin(pg/ml) of patients with mild, moderately severe and severe disease was 146±165.21, 1297±439.44, 4361±1493.55 respectively. The difference among the groups were statistically significant. Mean serum procalcitonin(pg/ml) in patientswho developed complications was 3744±1827.05 and in those without complication it was 301±559.97.ROC curve evaluating the role of serum procalcitonin in predicting outcome of acute pancreatitis showed AUC of 0.985. A cutoff point of 1131.28pg/ml showed highest sensitivity (95.7%) & specificity (94.7%). Conclusion: Serum procalcitonin can be a new promising marker to predict severity and outcome of acute pancreatitis. Bangladesh Crit Care J March 2021; 9(1): 16-21

Idiopathic Colonic Varix: Presenting as Lower GI Bleeding in an Elderly Male

not available Bangladesh Crit Care J March 2021; 9(1): 62-64