Pulse

An Interesting Finding of ‘Hot Clot Artifact’ on 18F-FDG PET/CT scan – A Case Report

2024-01-10T09:58:53+00:00

18F-fluorodeoxyglucose (18F-FDG) Positron Emission Tomography/- Computed Tomography (PET/CT) scan of oncological patients for the evaluation of disease status and treatment response has become a standard procedure of care. Abnormally increased 18F-FDG uptake represents abnormal findings. However, the area of increased uptake is not always associated with pathology. One such condition is the “hot clot artifact” or “pulmonary microembolism” in which there is intense focal FDG uptake in the lung without any corresponding CT-detectable structural lesion. Awareness of this condition is essential because it may cause misinterpretation as lung metastasis. Herein, we present a case showing focal FDG uptake in lung parenchyma without any structural lesion on CT scan, which subsequently resolved in follow-up imaging. Our case strengthens the importance of knowledge of this finding as misinterpretation of this can have a significant effect on patient management.

Pulse Vol.15, 2023 P: 41-44

Ongoing Challenges of Extubation of COVID-Pneumonic Patient in Multi-Organ Failure: a Case Report

2024-01-10T08:55:33+00:00

In this report, a case of a patient with COVID-19 pneumonia is presented who developed multi-organ failure and required mechanical ventilation. Despite multiple attempts at extubation, the patient remained intubated for an extended period due to respiratory failure. The challenges encountered during the process of extubation are discussed and the strategies employed to overcome them. This case highlights the importance of careful decision and management in patients with COVID-19 pneumonia for extubation who develop multi-organ failure.

Pulse Vol.15, 2023 P: 45-50

Detection of a Rare Blood Group ‘Bombay (Oh) Phenotype’ – A case report from Asgar Ali Hospital

2024-01-10T09:42:05+00:00

Bombay blood group is a rare blood type. It was first discovered in Bombay (Mumbai) in India. At the time of blood grouping, this blood group mimics O blood group due to the absence of H antigen, but it shows incompatibility with O group blood during cross-matching. Serum grouping or reverse grouping is essential for confirmation of the diagnosis. Patients carrying this blood group can receive blood only from a person with this blood group. Here, we present a case of Bombay phenotype in a patient with subarachnoid hemorrhage.

Pulse Vol.15, 2023 P: 51-53

Role of Transfusion Medicine Specialist in Stem Cell Transplant: Experience in Bangladesh

2024-01-10T08:19:21+00:00

Over the years, the field that was once known as blood banking has evolved into the discipline of Transfusion Medicine. Transfusion Medicine has become a broad, multidisciplinary field which include various facets of clinical medicine. Transfusion medicine specialist plays a vital role in the supportive care of patients undergoing stem cell transplantation, with a spectrum of applications including peripheral blood stem cell collection, graft manipulation, cryopreservation, donor lymphocyte infusions and evaluation of immunohematological issues in ABO and RhD mismatched and other transplant situations.

Pulse Vol.15, 2023 P: 34-37

Prevalence of ‘Weak D’ Phenotype in Patients in A Specialized Hospital

2024-01-10T08:26:12+00:00

Background: The Rhesus (Rh) blood group is the most immunogenic blood group in humans among all blood groups. It is one of the complex systems in immunohematology containing 56 different antigens. The Rh blood group shows variable expression of D antigen due to gene polymorphism. The variable expressions are weak D, partial D, and DEL.

Materials and Methods: A retrospective observational study was conducted at Evercare Hospital Chattogram from April 2021 to March 2023. Blood samples obtained for ABO and RhD blood grouping were tested by column agglutination technique. RhD negative samples were further tested for Du testing to identify weak-D phenotype.

Results: A total of 5700 blood samples were taken from patients. Out of these 5496 (96.5%) were RhD positive while 204 (3.5%) were RhD negative. Among Rh D negative cases, 4 were weak-D positive constituting 1.9% among Rh D negatives and 0.07% among total patients.

Conclusion: All RhD negative samples should be checked for Du testing. We must take caution on application of the Du test. It may be used to decrease the burden of RhD negative transfusion.

Pulse Vol.15, 2023 P: 38-40

Proactive Risk Management using Healthcare Failure Mode Effect Analysis Tool to Improve Medication Management Process

2024-01-10T04:57:50+00:00

Proactive risk management program is essential to maintain the quality and safety of patient care, treatment, and services within a healthcare system. According to the Joint Commission, hospitals need to adopt a proactive approach for risk management and develop risk mitigation strategies to reduce or eliminate the potentially harmful impact of possible risk. There are multiple tools that can be used for proactive analysis. Leaders of Evercare hospital Dhaka selected Healthcare FMEA tool to identify the potential failure modes in the current medication management process as it is one of the complex and high processes in healthcare settings. A multidisciplinary Healthcare FMEA team was formed comprising physician, nurse, pharmacist, quality, IT personnel and senior managements of EHD to conduct Healthcare FMEA. After completing Healthcare FMEA, twenty failure modes(n-20) and fifty-nine potential causes(n-59) of failure modes were detected in existing medication management process of EHD. The hazardous score was Two hundred & seventeen (n-217). There were Twelve major failures modes with higher hazardous score. Healthcare FMEA team members decided to eliminate major failures and actions were taken to control these failures. The main objective of this study is to maintain the medication error of EHD within the target (2/1000 patient days) by implementing required strategies and redesigning existing medication management process. The limitation of this study was it is a time-consuming process, it only helps to identify the possibilities of fail; it does not eliminate them, additional efforts are required to develop corrective action.

Pulse Vol.15, 2023 P: 28-33

CME of Evercare Hospital Dhaka - 2023 (Jan - Nov)

2024-01-10T09:49:00+00:00

Abstract not available

Pulse Vol.15, 2023 P: 54-55

Instruction to Authors Vol. 15

2024-01-10T09:56:10+00:00

Abstract not available

Pulse Vol.15, 2023 P: 56-58

Pulse Message Vol. 15

2024-01-10T10:09:16+00:00

Abstract not available

Pulse Vol.15, 2023 P: 59

Detection of Ureaplasma Species in Urogenital Samples by Real-Time PCR in Suspected Sexually Transmitted Infection Patients Attended in Evercare Hospital Dhaka in 2022

2024-01-10T04:57:59+00:00

Background: Sexually Transmitted Infections (STIs) are a continual and under-diagnosed disease. Mycoplasma hominis (M. hominis), Ureaplasma urealyticum (U. urealyticum), Ureaplasma parvum (U. parvum) are potential pathogens for urogenital infection of males and females. However, the association of these pathogens with STIs in our country is not yet reported. To determine the existence of M. hominis, U. urealyticum, U. parvum urogenital samples from suspected STIs patients who attended Evercare Hospital Dhaka were investigated.

Materials and methods: Extracted DNA from urine, prostatic secretion, urethral swab, and high vaginal swab as per clinician’s recommendation from 50 cases already tested negative for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis were used in this study from February 2022 to August 2022. Extracted and stored DNA were screened by multiplex real-time PCR for M. hominis, U. urealyticum, U. parvum.

Result: Ureaplasma was detected in 12 (24%) samples, U. parvum in 9 (75%), and U. urealyticum in 3 (25%) samples. No pathogens were isolated by routine culture from any of these samples. The positivity rate was more frequent in males (66.6%) than females (33.4%) and in the age group between 19-40 years old.

Conclusion: Our data show a significant association of Ureaplasma in STIs patients who attended this hospital. Large scale study is recommended for exploring the prevalence in the community and the role of this pathogen in STIs.

Pulse Vol.15, 2023 P: 5-8

Evaluation of Long-term Outcome of Arthroscopic Reconstruction of Anterior Cruciate Ligament Injury by Hamstring quadrupled Auto graft fixed by Bio Screws in a tertiary level hospital

2024-01-10T04:57:46+00:00

Background: Hamstring tendon auto grafts in the form of quadrupled semitendinosus and gracilis (STG) has become an increasingly used alternative for anterior cruciate ligament (ACL) reconstruction. Bio screw avoids complications by decreasing possibility of graft damage. Current study was designed to evaluate arthroscopic ACL reconstruction with quadrupled semitendinosus auto graft and fixation of the graft by two biodegradable screws in both femur and tibia.

Objectives: This study was conducted to evaluate the outcome of arthroscopic ACL reconstruction by semitendinosus tendon autograft using biodegradable screws for both tibia and femur. Methods: 300 patients with ACL injury admitted from January 2010 to December 2015 in the then Apollo Hospitals Dhaka (Evercare Hospital Dhaka now) were enrolled. All patients underwent ACL reconstruction surgery by quadrupled semitendinosus or gracilis auto graft fixed by Bio Screws. After discharge, these patients were followed up for 3 weeks, 3 months and final outcome was recorded after 6 years.

Results: 270 patients (90%) had an uneventful post-operative period. 200 patients (66.67%) complained of postoperative pain after 3 weeks, 10 patients (3.33%) complained of knee swelling, 10 (3.33%) patients had infections & 20 patients (6.65%) had knee stiffness after 6 months. Postoperatively, Lachman test improved significantly, grade 0 in 93.33% cases (280 patients) and grade I was in 6.67% cases (20 patients). Anterior drawer test was also markedly improved. Grade 0 was in 93.33% cases (280 patients) and grade I was in 6.67% cases (20 patients). According to the Lysholm Knee Scoring, the final long-term outcome was excellent in 76.67% cases (230 patients), good in 20% cases (60 patients) and fair in 3.33% cases (10 patients).

Conclusion: Arthroscopic reconstruction of ACL by quadrupled hamstring autograft fixed by biodegradable screws for both tibia and femur, leads good to excellent results in the majority of the cases.

Pulse Vol.15, 2023 P: 9-15

Utility of Immunohistochemistry in the Subtyping of Lung Carcinoma on Small Biopsies

2024-01-10T04:57:48+00:00

Background: Hamstring tendon auto grafts in the form of quadrupled Background and objectives: In the era of precision medicine, the important task of today’s pathologist is to classify lung carcinoma into specific histologic subtypes. Thus enables the scope to identify the molecular target for targeted therapy. Hematoxylin and eosin stain alone cannot subtype lung carcinoma when particularly it exhibits solid pattern of growth. This challenge becomes more pronounced when working with small biopsy samples.

Methodology and result: A retrospective cross-sectional study was conducted to evaluate small biopsies obtained by image guided lung core or bronchoscopy over three years, from 2020-2022. Tumour morphology was evaluated, and immunohistochemistry was performed in 132 cases of lung carcinoma. In this study a small panel of three markers (TTF-1, p63 and synaptophysin) was applied as an initial approach to classify different subtypes of lung carcinoma. Additional markers (such as NapsinA, p40, CK5/6, CD56, INSM1, CK7, CK20, etc.) were incorporated based on factors like morphological characteristics, clinical information, imaging data, and the results of the initial marker panel. The largest group observed in this study comprised 67% of adenocarcinomas that showed positivity for either TTF-1 or NapsinA. Squamous cell carcinomas, identified either through p63 expression or other markers such as p40/CK5/6, accounted for 26% of cases. Additionally, 10% of cases demonstrated reactivity to neuroendocrine markers, indicating the presence of neuroendocrine tumors. Notably, immunohistochemistry successfully identified the metastatic site for 10 adenocarcinomas that were negative for both TTF-1 and NapsinA.

Conclusion: A small panel of immunomarkers can classify the lung cancer reliably and increases the confidence at all level of lung cancer management.

Pulse Vol.15, 2023 P: 16-21

Detection of Non-Tuberculous Mycobacteria by PCR from Non-healing Surgical site Infections

2024-01-10T04:57:49+00:00

Surgical Site Infection (SSI) is an infection that occurs after any surgical procedure with adverse effects on a patient’s prognosis. SSIs are caused by a variety of bacteria including Non-Tuberculous Mycobacteria (NTM). Nowadays, NTM is reported as an important pathogen in delayed healing of surgical site infections in post-operative cases in many countries, however, there is no report yet in the country due to lacking any sensitive detection method. By multiplex PCR we previously reported the existence of NTM in a variety of clinical specimens and here we report NTM in SSI. Out of 98 patients with SSI, the total NTM positive cases were 20(20.4%) and Mycobacterium Tuberculosis (MTB) was 6(6.1%). NTM positivity rate was higher in female 13(65%) than male 7(35%). The majority (13) of the patients were treated with a combination of Clarithromycin and Ciprofloxacin with or without the first line of Anti-Tubercular Therapy (ATT) and cured. In the case of patients with delayed recovery of SSI, there should be a high level of clinical suspicion for the NTM as a causative agent and Multiplex PCR can be utilized to diagnose NTM and to discriminate from MTB.

Pulse Vol.15, 2023 P: 22-27

Dengue outbreak 2023: Awareness can lower the burden of dengue infection and mortality

2024-01-10T04:19:50+00:00

Abstract not available

Pulse Vol.15, 2023 P: 3-4