Diagnosing and managing critically ill patients with renal dysfunction is an important part in th... more Diagnosing and managing critically ill patients with renal dysfunction is an important part in the management of critically ill. Renal replacement therapy (RRT) is being widely used in intensive care. Acute kidney injury (AKI) is frequently present in critically ill patients of the intensive care unit (ICU) as a part of multiple organ dysfunction syndrome (MODS). These patients have various co-morbid conditions and are on various life-supportive modalities. Fluid overload and electrolyte and acid-base disturbances and drugs may further injure their organ systems. RRT plays a significant role in ICU in the treatment of patients with renal failure, acute as well as chronic. However, the term 'RRT' is not
Aim of the study was to know the microorganisms profile and determine the antibiotic resistance p... more Aim of the study was to know the microorganisms profile and determine the antibiotic resistance pattern of the LRT isolates from mechanically ventilated (MV) patients admitted to the ICU. This prospective observational study was done in Department of Critical Care Medicine (ICU) of BIRDEM General Hospital Dhaka from July, 2011 to December, 2011. Methods: Methods: Methods: Methods: Methods: Blind Tracheal Aspirate or Broncho Alveolar Lavage or both from 110 consecutive patients (total 130 samples) admitted to the ICU requiring MV were cultured, identified, and antibiotic sensitivity was performed by standard methods. Results: Results: Results: Results: Results: A total of 130 samples were analyzed. Growth was obtained in 93.8% of the samples yielding 143 organisms. Many (21 samples) yielded more than one organism. The major organism isolated were Acinetobacter sp. (54.5%), Pseudomonas sp.(14.7%), Klebsiella sp. (7.7%).Candida sp. (7.0%), Staphylococcus aureus(7.0%), Escherichia coli (4.9%).Proteus and Flavobacterium accounted for 4.2% of the isolates. All the isolates were highly resistant (>90%) to cephalosporins and >70% to fluoroquinolones. The frequency of third generation cephalosporin resistant E. coli, Klebsiellaand imipenem resistant Pseudomonas and Acinetobacter were>90%. Acinetobacter was remarkably resistant to most antibiotics including imipenem (>90% resistant) and Piperacillin+Tazobactum (>85% resistant), but most of the members of the Enterobacteriacae group and Acinetobacter showed maximum sensitivity to colistin (80%-100%). Conclusion: Conclusion: Conclusion: Conclusion: Conclusion: Nonfermenters Gram Negative Bacilli (GNB)-Acinetobacter sp. & Pseudomonas sp. are the most common etiological agents of LRT infections in ICU. There is an alarmingly high rate of resistance to cephalosporin and ²β-lactamase inhibitor group of drugs. Colistin was found to be the most sensitive drug against all GNB.
We report university student perspectives on COVID-19 impact on education, general health and wel... more We report university student perspectives on COVID-19 impact on education, general health and well-being, one year into the pandemic. A ‘low risk’ questionnaire with modified General Health (GHQ-28) and Anxiety Disorder (GAD-7) instruments was shared with students via an email link over a 4-week period. 725 students responded from five countries. Half of the students reported significant general health difficulties and more than ten per cent experienced a severe state of generalised anxiety disorder. The virtual learning techniques adopted during the pandemic were welcomed by students but many were frustrated by the poor quality teaching material, poor scheduling of virtual sessions with inadequate spacing and assessments not being truly representative of what was taught. Digital poverty due to inadequacies in hardware, software compatibility and connectivity were major hindrances to virtual learning. Universities should urgently modify the virtual training methods and enhance...
Delirium is the most common psychiatric syndrome found in the general hospital setting specially ... more Delirium is the most common psychiatric syndrome found in the general hospital setting specially in the critical care units and thus often referred to as "ICU psychosis". Eisendrath 1 defined "ICU syndrome"/ "ICU psychosis" as an acute organic brain syndrome involving impaired intellectual functioning and occurring in patient treated in critical care unit.
RATIONALE There are limited data on mechanical discontinuation practices in Asia. OBJECTIVES To d... more RATIONALE There are limited data on mechanical discontinuation practices in Asia. OBJECTIVES To document self-reported mechanical discontinuation practices and determine whether there is clinical equipoise regarding protocolized weaning amongst Asian Intensive Care specialists. METHODS Survey using a validated questionnaire, distributed using a snowball method to Asian Intensive Care specialists. RESULTS Of 2,967 invited specialists from 20 territories, 2,074 (69.9%) took part. 60.5% were from China. 42% of all respondents worked in Intensive Care units where respiratory therapists were present. 78.9% used a spontaneous breathing trial as the initial weaning step. 44.3% frequently-always used pressure support alone, 53.4% intermittent spontaneous breathing trials with pressure support in between and 19.8% synchronized intermittent mandatory ventilation with pressure support as a weaning mode. 56.3% routinely stopped feeds before extubation. 71.5% generally followed a sedation protocol or guideline. 61.8% worked in an Intensive Care unit with a weaning protocol. Of these 78.2% frequently-always followed the protocol. Multivariate analysis involving a modified Poisson regression analysis showed that working in an Intensive Care unit with a weaning protocol and frequently-always following it was positively associated with upper-middle income territory, university affiliated hospital, or in an Intensive Care unit that employed respiratory therapists; and negatively with low-income or low-middle income territory or a public hospital. There was no significant association with "in house" intensivist at night, multidisciplinary Intensive Care unit, closed Intensive Care unit or nurse-patient ratio. There was heterogenity in agreement/disagreement with the statement "evidence clearly supports protocolized weaning over non-protocolized weaning". CONCLUSIONS A substantial minority of Asian Intensive Care specialists do not wean patients in accordance with best available evidence or current guidelines. There is clinical equipoise regarding the benefit of protocolized weaning.
Background and Objectives: For diagnosis of nosocomial pneumonia in patients on ventilator, invas... more Background and Objectives: For diagnosis of nosocomial pneumonia in patients on ventilator, invasive procedure like bronchoscopy for microscopy and quantitative cultures of lower respiratory tract samples is useful but not always possible for potential risk of the procedure and the associated cost. The non-bronchoscopic sampling of the lower airways and quantitative cultures of tracheal aspirate may offer simple and readily available alternative to bronchoscopy with promising results. This study was done to evaluate the efficacy of blind tracheal aspirate in the microbiological diagnosis of nosocomial pneumonia occurring in intubated patients on mechanical ventilator. Materials & Methods: This cross-sectional study was carried out in the Intensive Care Unit in the Department of Critical Care Medicine, BIRDEM Hospital, Dhaka over a period 16 months starting from January 2010 to April 2011. A total of 54 clinically diagnosed cases of nosocomial (hospital acquired) pneumonia who were o...
Melioidosis has recently gained importance as an emerging disease in Bangladesh. It is endemic in... more Melioidosis has recently gained importance as an emerging disease in Bangladesh. It is endemic in SouthEast Asia and Northern Australia. In Bangladesh few cases have been reported mainly from NorthEastern part of the country (greater Mymensingh area). It can present with varied forms. Here, we are reporting a case of melioidosis, who initially presented with prolonged pyrexia and later hepatic abscess was detected on imaging. Culture of aspirated pus from hepatic lesion revealed growth of Burkholderia pseudomallei. The patient resided in Chittagong hill tracts of Bangladesh.
Objective: Hypomagnesemia is one of the common electrolyte disorders found in critically ill pati... more Objective: Hypomagnesemia is one of the common electrolyte disorders found in critically ill patients. It is often an incidental finding and usually its importance is ignored. This study was designed to assess the significance of the impact of hypomagnesemia on the mortality and morbidity of the ICU patients. Hence the efficacy of hypomagnesemia as prognostic marker was also tested.Method: Prospective cohort study done at the department of Critical Care Medicine, of a tertiary care hospital in the city of Dhaka, Bangladesh (from January 2014 to December 2014) aiming to find out of the differences in mortality & morbidity between two groups of patients one with low and other with normal Mg level.Result: 95 adult ICU admitted patients were included in the study and 38% of the study subjects were found to be Hypomagnesemic. The Hypomagnesemic group of patients needed more frequent ventilator support (75% vs 52.54%, p<0.02) and the duration of mechanical ventilator support was also...
Lithium Carbonate is the first line treatment for bipolar depressive disorder. It also has benefi... more Lithium Carbonate is the first line treatment for bipolar depressive disorder. It also has beneficial effects on prophylactic use in Acute manic episodes to prevent recurrence and reduces rate of suicide associated with affective disorder. Low therapeutic index of Lithium (0.8-1.2meq/l) mandates regular and frequent measurement of Serum lithium level in patients taking this drug. Here we present a 59 years Indian male who is a known diabetic, chronic alcoholic and a case of bipolar disorder. He was on Lithium tablet off and on for last 4 years and was also on oral antidiabetic agent. He was admitted in ICU through emergency with complaints of altered level of consciousness for 2 days with H/O recurrent hypoglycemia associated with nausea, reduced food intake, vertigo, tremor of all four limbs with weakness of both lower limbs for approximately last 2 months. Admission serum lithium level was 2.24meq/l. Hemodialysis was started. Neurological symptoms improved and serum Lithium level ...
Background Asia has more critically ill people than any other part of our planet. The aim of this... more Background Asia has more critically ill people than any other part of our planet. The aim of this article is to review the development of critical care as a specialty, critical care societies and education and research, the epidemiology of critical illness as well as epidemics and pandemics, accessibility and cost and quality of critical care, culture and end-of-life care, and future directions for critical care in Asia. Main body Although the first Asian intensive care units (ICUs) surfaced in the 1960s and the 1970s and specialisation started in the 1990s, multiple challenges still exist, including the lack of intensivists, critical care nurses, and respiratory therapists in many countries. This is aggravated by the brain drain of skilled ICU staff to high-income countries. Critical care societies have been integral to the development of the discipline and have increasingly contributed to critical care education, although critical care research is only just starting to take off th...
Background: The number of organisms developing resistance to commonly used antibiotics is increas... more Background: The number of organisms developing resistance to commonly used antibiotics is increasing day by day. The exact national scenario of antimicrobial sensitivity pattern is not well known in Bangladesh owing to the absence of proper guideline for prescribing antibiotics. Aims: The aim of this study is to identify the group of organisms developing resistanceso that antibiotic policy can be formulated for the proper and effective use of antibiotics. Settings and Design: This observational study was conducted for a period of 1 year from January 2018 to December 2018 in a tertiary care hospital in Bangladesh. Materials and methods: This descriptive cross-sectional study was conducted in the Department of Microbiology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from January 2018 to December 2018, using the convenient sampling technique. Tracheal secretions from patients in the intensive care unit (ICU), tested in Department of Microbiology, National Insti...
Background: Approximately 7% of all hospitalized patients and 20% of acutely ill patients develop... more Background: Approximately 7% of all hospitalized patients and 20% of acutely ill patients develop signs of AKI. AKI incidence is very high worldwide among intensive care unit patients. Previously long known term, acute renal failure (ARF) is largely replaced by acute kidney injury (AKI), reflecting the recognition that smaller decrements in kidney function that do not result in overt organ failure are of substantial clinical relevance and are associated with increased morbidity and mortality. Objectives: We designed this study to diagnose even mild renal dysfunction earlier than usual time frame with the combined effect of both serum creatinine and urine output criteria, when compared with serum creatinine criterion alone. To establish this objective we used RIFLE serum creatinine and urine output (UO) criteria combined (Scr+UO) and compared with RIFLE serum creatinine (Scr) alone to diagnose AKI early (in days). Design: Prospective observational cohort study. Duration of the study ...
We present a case of a 45 years old male, diabetic and hypertensive who was admited into hospital... more We present a case of a 45 years old male, diabetic and hypertensive who was admited into hospital with a history ofrestlessness, blurring of vision and breathlessness for one day. Inspite of conservative treatment for 10 hours, hisgeneral condition gradually detoriated and he was shifted to ICU. He was kept on mechanical ventilator. Hislaboratory results showed severe high anion gap metabolic acidosis not corrected by sodibicarb and adequate fluidresuscitation. MRI of brain showed bilateral putamenal lesion suspecting methanol intoxication. His acidosis persistedand after giving 3 sessions of Sustained Low Efficiency Dialysis (SLED), metabolic acidosis was corrected withnormalization of renal function. After six months in a follow-up, patient complained of total blindness and fundalphotography showed bilateral optic atrophy. Bangladesh Crit Care J September 2019; 7(2): 111-112
Acute Kidney Injury (AKI) is a common cause of morbidity and mortality worldwide. However it is a... more Acute Kidney Injury (AKI) is a common cause of morbidity and mortality worldwide. However it is a treatablecondition. Any disease when associated with AKI, mortality and morbidity increase manifolds.1 Early diagnosis andtreatment is important to reduce morbidity, mortality and ICU admission. Causes of AKI may vary in country to countryeven within the country. International society of Nephrology has set a high ambitious goal “0 by 25” targeting zerodeath due to untreated AKI by 2025. Heading this challenge, it is important to know the causes of AKI worldwide.However, most of the AKI studies have been done in the developed countries and limited information is availableregarding Asia, Africa and south America. Inspired by this slogan, this study was directed to find out the causes of AKIin admitted patients in United Hospital Limited between July 2015 to February 2017. Total 98 patients were includedin the study. In our study, Infection and cardio-renal syndrome were the leading causes...
Context: Ventilator-associated pneumonia (VAP) causes substantial morbidity and mortality. The in... more Context: Ventilator-associated pneumonia (VAP) causes substantial morbidity and mortality. The influence of intermittent subglottic secretion drainage (SSD) in preventing VAP has been supported by literature studies.Objective: To find out the effectiveness of subglottic secretion drainage (SSD) on prevention of ventilator associated pneumonia (VAP) using endotracheal tube with subglottic secretion drainage (ETT-SSD).Methodology: This study was carried out in the 10 beded medical-care Intensive Care Unit (ICU) of BIRDEM Hospital, Dhaka over a period of one and half year, enrolling 48 subjects. Patients expected to require mechanical ventilation (MV) for more than >48 hrs were randomly assigned to one of two groups: one was ventilated with ETT-SSD and the other with conventional endotracheal tube (ETT-C).Results: Primary outcome was the overall incidence of VAP based on quantitative culture of distal pulmonary samplings performed after each clinical suspicion. Other outcomes includ...
The diagnosis of brain death has important medical, ethical and legal implications. Death is defi... more The diagnosis of brain death has important medical, ethical and legal implications. Death is defined as "An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brain stem (otherwise called Brain Death), is dead. 1" A determination of death must be made in accordance with accepted medical standards. Brain death is a concept that entered clinical practice when mechanical ventilators made it possible to artificially sustain patients after brain function ceased. Traditionally, a patient was considered alive until the heart stopped, but with the advent of modern life support techniques, the heart can continue to beat even when there is irreversible cessation of brain function. Brain death is a state of cessation of cerebral function wherein the proximate cause is known and is considered irreversible. The American Academy of Neurology (AAN) has defined brain death with three cardinal signs, cessation of the functions of the brain including the brainstem, coma or unresponsiveness and apnea. 2 According to the literature, no patients have recovered after a brain death declaration using AAN guidelines. The concept of brain death was first introduced in United States in 1968 (Ad hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death, 1968) in part to facilitate organ donation. 3 Studies done elsewhere suggest lack of awareness and misunderstanding on many issues regarding brain death, persistent vegetative state (PVS) and differentiation between severe brain injury versus brain death. 4,5 At times, the ethical and religious considerations have also been found to affect decisions regarding diagnosis of brain death. 6,7,8. The concept of brain death was accepted by a majority of scholars and jurists at the Third International Conference of Islamic Jurists in Amman, Jordan, in 1986. 9 Brain death declaration has been legalized in Bangladesh in 1999 (No-5 under "Transplantation of Organ Act, 1999)." 10 In many countries, including India, the diagnosis of brain death is made after fulfilling the mandatory criteria and by the apnea testing which is a safe technique for documentation. 11 In India the deceased donor organ donation rate is only 0.26 per million 12 while USA at 25.6 per million 13 , and UK at 18.3 per million 14 are well ahead.
Objective: To see the clinical presentation and biochemical abnormalities in hospitalized patient... more Objective: To see the clinical presentation and biochemical abnormalities in hospitalized patients of Diabetic ketoacidosis.
Diagnosing and managing critically ill patients with renal dysfunction is an important part in th... more Diagnosing and managing critically ill patients with renal dysfunction is an important part in the management of critically ill. Renal replacement therapy (RRT) is being widely used in intensive care. Acute kidney injury (AKI) is frequently present in critically ill patients of the intensive care unit (ICU) as a part of multiple organ dysfunction syndrome (MODS). These patients have various co-morbid conditions and are on various life-supportive modalities. Fluid overload and electrolyte and acid-base disturbances and drugs may further injure their organ systems. RRT plays a significant role in ICU in the treatment of patients with renal failure, acute as well as chronic. However, the term 'RRT' is not
Aim of the study was to know the microorganisms profile and determine the antibiotic resistance p... more Aim of the study was to know the microorganisms profile and determine the antibiotic resistance pattern of the LRT isolates from mechanically ventilated (MV) patients admitted to the ICU. This prospective observational study was done in Department of Critical Care Medicine (ICU) of BIRDEM General Hospital Dhaka from July, 2011 to December, 2011. Methods: Methods: Methods: Methods: Methods: Blind Tracheal Aspirate or Broncho Alveolar Lavage or both from 110 consecutive patients (total 130 samples) admitted to the ICU requiring MV were cultured, identified, and antibiotic sensitivity was performed by standard methods. Results: Results: Results: Results: Results: A total of 130 samples were analyzed. Growth was obtained in 93.8% of the samples yielding 143 organisms. Many (21 samples) yielded more than one organism. The major organism isolated were Acinetobacter sp. (54.5%), Pseudomonas sp.(14.7%), Klebsiella sp. (7.7%).Candida sp. (7.0%), Staphylococcus aureus(7.0%), Escherichia coli (4.9%).Proteus and Flavobacterium accounted for 4.2% of the isolates. All the isolates were highly resistant (>90%) to cephalosporins and >70% to fluoroquinolones. The frequency of third generation cephalosporin resistant E. coli, Klebsiellaand imipenem resistant Pseudomonas and Acinetobacter were>90%. Acinetobacter was remarkably resistant to most antibiotics including imipenem (>90% resistant) and Piperacillin+Tazobactum (>85% resistant), but most of the members of the Enterobacteriacae group and Acinetobacter showed maximum sensitivity to colistin (80%-100%). Conclusion: Conclusion: Conclusion: Conclusion: Conclusion: Nonfermenters Gram Negative Bacilli (GNB)-Acinetobacter sp. & Pseudomonas sp. are the most common etiological agents of LRT infections in ICU. There is an alarmingly high rate of resistance to cephalosporin and ²β-lactamase inhibitor group of drugs. Colistin was found to be the most sensitive drug against all GNB.
We report university student perspectives on COVID-19 impact on education, general health and wel... more We report university student perspectives on COVID-19 impact on education, general health and well-being, one year into the pandemic. A ‘low risk’ questionnaire with modified General Health (GHQ-28) and Anxiety Disorder (GAD-7) instruments was shared with students via an email link over a 4-week period. 725 students responded from five countries. Half of the students reported significant general health difficulties and more than ten per cent experienced a severe state of generalised anxiety disorder. The virtual learning techniques adopted during the pandemic were welcomed by students but many were frustrated by the poor quality teaching material, poor scheduling of virtual sessions with inadequate spacing and assessments not being truly representative of what was taught. Digital poverty due to inadequacies in hardware, software compatibility and connectivity were major hindrances to virtual learning. Universities should urgently modify the virtual training methods and enhance...
Delirium is the most common psychiatric syndrome found in the general hospital setting specially ... more Delirium is the most common psychiatric syndrome found in the general hospital setting specially in the critical care units and thus often referred to as "ICU psychosis". Eisendrath 1 defined "ICU syndrome"/ "ICU psychosis" as an acute organic brain syndrome involving impaired intellectual functioning and occurring in patient treated in critical care unit.
RATIONALE There are limited data on mechanical discontinuation practices in Asia. OBJECTIVES To d... more RATIONALE There are limited data on mechanical discontinuation practices in Asia. OBJECTIVES To document self-reported mechanical discontinuation practices and determine whether there is clinical equipoise regarding protocolized weaning amongst Asian Intensive Care specialists. METHODS Survey using a validated questionnaire, distributed using a snowball method to Asian Intensive Care specialists. RESULTS Of 2,967 invited specialists from 20 territories, 2,074 (69.9%) took part. 60.5% were from China. 42% of all respondents worked in Intensive Care units where respiratory therapists were present. 78.9% used a spontaneous breathing trial as the initial weaning step. 44.3% frequently-always used pressure support alone, 53.4% intermittent spontaneous breathing trials with pressure support in between and 19.8% synchronized intermittent mandatory ventilation with pressure support as a weaning mode. 56.3% routinely stopped feeds before extubation. 71.5% generally followed a sedation protocol or guideline. 61.8% worked in an Intensive Care unit with a weaning protocol. Of these 78.2% frequently-always followed the protocol. Multivariate analysis involving a modified Poisson regression analysis showed that working in an Intensive Care unit with a weaning protocol and frequently-always following it was positively associated with upper-middle income territory, university affiliated hospital, or in an Intensive Care unit that employed respiratory therapists; and negatively with low-income or low-middle income territory or a public hospital. There was no significant association with "in house" intensivist at night, multidisciplinary Intensive Care unit, closed Intensive Care unit or nurse-patient ratio. There was heterogenity in agreement/disagreement with the statement "evidence clearly supports protocolized weaning over non-protocolized weaning". CONCLUSIONS A substantial minority of Asian Intensive Care specialists do not wean patients in accordance with best available evidence or current guidelines. There is clinical equipoise regarding the benefit of protocolized weaning.
Background and Objectives: For diagnosis of nosocomial pneumonia in patients on ventilator, invas... more Background and Objectives: For diagnosis of nosocomial pneumonia in patients on ventilator, invasive procedure like bronchoscopy for microscopy and quantitative cultures of lower respiratory tract samples is useful but not always possible for potential risk of the procedure and the associated cost. The non-bronchoscopic sampling of the lower airways and quantitative cultures of tracheal aspirate may offer simple and readily available alternative to bronchoscopy with promising results. This study was done to evaluate the efficacy of blind tracheal aspirate in the microbiological diagnosis of nosocomial pneumonia occurring in intubated patients on mechanical ventilator. Materials & Methods: This cross-sectional study was carried out in the Intensive Care Unit in the Department of Critical Care Medicine, BIRDEM Hospital, Dhaka over a period 16 months starting from January 2010 to April 2011. A total of 54 clinically diagnosed cases of nosocomial (hospital acquired) pneumonia who were o...
Melioidosis has recently gained importance as an emerging disease in Bangladesh. It is endemic in... more Melioidosis has recently gained importance as an emerging disease in Bangladesh. It is endemic in SouthEast Asia and Northern Australia. In Bangladesh few cases have been reported mainly from NorthEastern part of the country (greater Mymensingh area). It can present with varied forms. Here, we are reporting a case of melioidosis, who initially presented with prolonged pyrexia and later hepatic abscess was detected on imaging. Culture of aspirated pus from hepatic lesion revealed growth of Burkholderia pseudomallei. The patient resided in Chittagong hill tracts of Bangladesh.
Objective: Hypomagnesemia is one of the common electrolyte disorders found in critically ill pati... more Objective: Hypomagnesemia is one of the common electrolyte disorders found in critically ill patients. It is often an incidental finding and usually its importance is ignored. This study was designed to assess the significance of the impact of hypomagnesemia on the mortality and morbidity of the ICU patients. Hence the efficacy of hypomagnesemia as prognostic marker was also tested.Method: Prospective cohort study done at the department of Critical Care Medicine, of a tertiary care hospital in the city of Dhaka, Bangladesh (from January 2014 to December 2014) aiming to find out of the differences in mortality & morbidity between two groups of patients one with low and other with normal Mg level.Result: 95 adult ICU admitted patients were included in the study and 38% of the study subjects were found to be Hypomagnesemic. The Hypomagnesemic group of patients needed more frequent ventilator support (75% vs 52.54%, p<0.02) and the duration of mechanical ventilator support was also...
Lithium Carbonate is the first line treatment for bipolar depressive disorder. It also has benefi... more Lithium Carbonate is the first line treatment for bipolar depressive disorder. It also has beneficial effects on prophylactic use in Acute manic episodes to prevent recurrence and reduces rate of suicide associated with affective disorder. Low therapeutic index of Lithium (0.8-1.2meq/l) mandates regular and frequent measurement of Serum lithium level in patients taking this drug. Here we present a 59 years Indian male who is a known diabetic, chronic alcoholic and a case of bipolar disorder. He was on Lithium tablet off and on for last 4 years and was also on oral antidiabetic agent. He was admitted in ICU through emergency with complaints of altered level of consciousness for 2 days with H/O recurrent hypoglycemia associated with nausea, reduced food intake, vertigo, tremor of all four limbs with weakness of both lower limbs for approximately last 2 months. Admission serum lithium level was 2.24meq/l. Hemodialysis was started. Neurological symptoms improved and serum Lithium level ...
Background Asia has more critically ill people than any other part of our planet. The aim of this... more Background Asia has more critically ill people than any other part of our planet. The aim of this article is to review the development of critical care as a specialty, critical care societies and education and research, the epidemiology of critical illness as well as epidemics and pandemics, accessibility and cost and quality of critical care, culture and end-of-life care, and future directions for critical care in Asia. Main body Although the first Asian intensive care units (ICUs) surfaced in the 1960s and the 1970s and specialisation started in the 1990s, multiple challenges still exist, including the lack of intensivists, critical care nurses, and respiratory therapists in many countries. This is aggravated by the brain drain of skilled ICU staff to high-income countries. Critical care societies have been integral to the development of the discipline and have increasingly contributed to critical care education, although critical care research is only just starting to take off th...
Background: The number of organisms developing resistance to commonly used antibiotics is increas... more Background: The number of organisms developing resistance to commonly used antibiotics is increasing day by day. The exact national scenario of antimicrobial sensitivity pattern is not well known in Bangladesh owing to the absence of proper guideline for prescribing antibiotics. Aims: The aim of this study is to identify the group of organisms developing resistanceso that antibiotic policy can be formulated for the proper and effective use of antibiotics. Settings and Design: This observational study was conducted for a period of 1 year from January 2018 to December 2018 in a tertiary care hospital in Bangladesh. Materials and methods: This descriptive cross-sectional study was conducted in the Department of Microbiology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from January 2018 to December 2018, using the convenient sampling technique. Tracheal secretions from patients in the intensive care unit (ICU), tested in Department of Microbiology, National Insti...
Background: Approximately 7% of all hospitalized patients and 20% of acutely ill patients develop... more Background: Approximately 7% of all hospitalized patients and 20% of acutely ill patients develop signs of AKI. AKI incidence is very high worldwide among intensive care unit patients. Previously long known term, acute renal failure (ARF) is largely replaced by acute kidney injury (AKI), reflecting the recognition that smaller decrements in kidney function that do not result in overt organ failure are of substantial clinical relevance and are associated with increased morbidity and mortality. Objectives: We designed this study to diagnose even mild renal dysfunction earlier than usual time frame with the combined effect of both serum creatinine and urine output criteria, when compared with serum creatinine criterion alone. To establish this objective we used RIFLE serum creatinine and urine output (UO) criteria combined (Scr+UO) and compared with RIFLE serum creatinine (Scr) alone to diagnose AKI early (in days). Design: Prospective observational cohort study. Duration of the study ...
We present a case of a 45 years old male, diabetic and hypertensive who was admited into hospital... more We present a case of a 45 years old male, diabetic and hypertensive who was admited into hospital with a history ofrestlessness, blurring of vision and breathlessness for one day. Inspite of conservative treatment for 10 hours, hisgeneral condition gradually detoriated and he was shifted to ICU. He was kept on mechanical ventilator. Hislaboratory results showed severe high anion gap metabolic acidosis not corrected by sodibicarb and adequate fluidresuscitation. MRI of brain showed bilateral putamenal lesion suspecting methanol intoxication. His acidosis persistedand after giving 3 sessions of Sustained Low Efficiency Dialysis (SLED), metabolic acidosis was corrected withnormalization of renal function. After six months in a follow-up, patient complained of total blindness and fundalphotography showed bilateral optic atrophy. Bangladesh Crit Care J September 2019; 7(2): 111-112
Acute Kidney Injury (AKI) is a common cause of morbidity and mortality worldwide. However it is a... more Acute Kidney Injury (AKI) is a common cause of morbidity and mortality worldwide. However it is a treatablecondition. Any disease when associated with AKI, mortality and morbidity increase manifolds.1 Early diagnosis andtreatment is important to reduce morbidity, mortality and ICU admission. Causes of AKI may vary in country to countryeven within the country. International society of Nephrology has set a high ambitious goal “0 by 25” targeting zerodeath due to untreated AKI by 2025. Heading this challenge, it is important to know the causes of AKI worldwide.However, most of the AKI studies have been done in the developed countries and limited information is availableregarding Asia, Africa and south America. Inspired by this slogan, this study was directed to find out the causes of AKIin admitted patients in United Hospital Limited between July 2015 to February 2017. Total 98 patients were includedin the study. In our study, Infection and cardio-renal syndrome were the leading causes...
Context: Ventilator-associated pneumonia (VAP) causes substantial morbidity and mortality. The in... more Context: Ventilator-associated pneumonia (VAP) causes substantial morbidity and mortality. The influence of intermittent subglottic secretion drainage (SSD) in preventing VAP has been supported by literature studies.Objective: To find out the effectiveness of subglottic secretion drainage (SSD) on prevention of ventilator associated pneumonia (VAP) using endotracheal tube with subglottic secretion drainage (ETT-SSD).Methodology: This study was carried out in the 10 beded medical-care Intensive Care Unit (ICU) of BIRDEM Hospital, Dhaka over a period of one and half year, enrolling 48 subjects. Patients expected to require mechanical ventilation (MV) for more than >48 hrs were randomly assigned to one of two groups: one was ventilated with ETT-SSD and the other with conventional endotracheal tube (ETT-C).Results: Primary outcome was the overall incidence of VAP based on quantitative culture of distal pulmonary samplings performed after each clinical suspicion. Other outcomes includ...
The diagnosis of brain death has important medical, ethical and legal implications. Death is defi... more The diagnosis of brain death has important medical, ethical and legal implications. Death is defined as "An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brain stem (otherwise called Brain Death), is dead. 1" A determination of death must be made in accordance with accepted medical standards. Brain death is a concept that entered clinical practice when mechanical ventilators made it possible to artificially sustain patients after brain function ceased. Traditionally, a patient was considered alive until the heart stopped, but with the advent of modern life support techniques, the heart can continue to beat even when there is irreversible cessation of brain function. Brain death is a state of cessation of cerebral function wherein the proximate cause is known and is considered irreversible. The American Academy of Neurology (AAN) has defined brain death with three cardinal signs, cessation of the functions of the brain including the brainstem, coma or unresponsiveness and apnea. 2 According to the literature, no patients have recovered after a brain death declaration using AAN guidelines. The concept of brain death was first introduced in United States in 1968 (Ad hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death, 1968) in part to facilitate organ donation. 3 Studies done elsewhere suggest lack of awareness and misunderstanding on many issues regarding brain death, persistent vegetative state (PVS) and differentiation between severe brain injury versus brain death. 4,5 At times, the ethical and religious considerations have also been found to affect decisions regarding diagnosis of brain death. 6,7,8. The concept of brain death was accepted by a majority of scholars and jurists at the Third International Conference of Islamic Jurists in Amman, Jordan, in 1986. 9 Brain death declaration has been legalized in Bangladesh in 1999 (No-5 under "Transplantation of Organ Act, 1999)." 10 In many countries, including India, the diagnosis of brain death is made after fulfilling the mandatory criteria and by the apnea testing which is a safe technique for documentation. 11 In India the deceased donor organ donation rate is only 0.26 per million 12 while USA at 25.6 per million 13 , and UK at 18.3 per million 14 are well ahead.
Objective: To see the clinical presentation and biochemical abnormalities in hospitalized patient... more Objective: To see the clinical presentation and biochemical abnormalities in hospitalized patients of Diabetic ketoacidosis.
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Papers by Mohammad Faruq