Introduction: Acute kidney injury (AKI) is a common condition and its incidence is increasing . No study has been done so far on this subject in the Armed Forces. This retrospective study is therefore, to find out the incidence, etiology , predisposing factors, diagnostic approach, clinical course and finally outcome of the patients with AKI in this country, in a selected group of patients. Methods: This retrospective cross sectional study was conducted in Combined Military Hospital, Dhaka, from July 2007 to July 2011. Total 105 cases were included in this study. All were adult and their age of distribution was 18-80 years. Cases were studied in terms of etiology, mode of presentation, laboratory findings, management and response to treatment or outcome. Results: Mean age was 47.24+ 18.35 years. Male, female ratio was 3:2. Hypovolemia was the major (23.8%) etiological factor of AKI in this study due to acute gastroenteritis, 14.28% cases were due to different non-steroidal anti inflammatory drugs (NSAIDs), 9.52% cases due to rhabdomyolysis following physical assault and vigorous exercise, 7.61% cases were due to septicaemia, 8.57% cases were due to glomerulonephritis and 6.66% cases due to acute pyelonephritis.6.66% cases developed AKI due to falciparum malaria and 5.71% due to obstructive uropathy. Other causes of AKI in this study are –contrast induced nephropathy 3.8%,postoperative AKI 4.76%,AKI due to vasculitis 3.8%,2.85% cases due to HELLP syndrome,0.95% case due to snake bite and 0.95% case due to thrombotic thrombocytopenic purpura(TTP). Oliguria (66.66%) and oedema (64.76%) were the commonest presentation in this study. Mean blood urea and serum creatinine level on admission being 9134 mg/dl and 4.292.55 mg/dl respectively. Haemodialysis was done in 44 cases, continuous renal replacement therapy (CRRT- continuous venovenous haemodialysis) was given in 6 patients, peritoneal dialysis in 5 patients and 49 cases were managed with conservative therapy alone. Complete recovery occurred in 88 patients, 8 had recovery with residual renal impairment, 6 patients developed end stage renal disease (ESRD) and 3 patients died due to septicaemia and multi-organ failure (MOF). Conclusion: Most of the cases of AKI are preventable if we can take due care of some common health problems like gastroenteritis and at the same time outcome can be rewarding if we can ensure early reporting, quick diagnosis and appropriate management DOI: http://dx.doi.org/10.3329/bjmed.v22i2.13587 Bangladesh J Medicine 2011; 22: 35-40

Neonatal respiratory distress (NRD) is a main cause of neonatal morbidity and mortality in developing countries. Early detection of its risk factors and early treatment of its causes are major challenges. There are many causes of respiratory distress, among them, transient tachypnea of newborn (TTN), respiratory distress syndrome (RDS) and perinatal asphyxia are commonest causes. Timely and appropriate therapy is essential to prevent ongoing injury and improve outcome. The aim of this study was to determine the risk factors and to identify the causes of respiratory distress in neonatal intensive care unit (NICU) in Combined Military hospital (CMH) Sylhet and to observe the hospital outcome of these babies. Descriptive type of cross- sectional study was conducted in CMH Sylhet over a period of one year from April 2018 to March 2019. During the study period a total of 287 live newborns were found and included as study subjects to observe for development of respiratory distress. The overall prevalence of respiratory distress was 19.2%. There was male predominance (63.6%) and more than two third (71.1%) were born by cesarean section. Prematurity (38.2%), low birth weight (52.7%), male gender (63.6%), APGAR at 1 min <7 (10.9%), caesarean delivery (76.4%), less antenatal care visit (52.7%), more than 4 pervaginal examinations 49.1%, acute fetal distress 43.6% and gestational diabetes mellitus 34.5% were the most common risk factors for development of NRD. The main causes were transient tachypnea of newborn 47.3%, respiratory distress syndrome 29.1% and perinatal asphyxia 10.9%. All babies required high flow oxygen initially, subsequently Bubble Continuous Positive Airway Pressure (CPAP) and mechanical ventilation was required in 14.5% and 1(1.8%) cases respectively. Mortality was 1.8% in neonates with respiratory distress syndrome with pneumothorax with septicaemia requiring mechanical ventilation. NRD is a frequent emergency and causes high morbidity and mortality. Risk factors like prematurity, low birth weight, male gender, APGAR at 1 min <7, caesarean delivery, less antenatal care visit, more than 4 pervaginal examinations, acute fetal distress and gestational diabetes mellitus were associated with respiratory distress in newborns. Majority of cases are due to TTN followed by respiratory distress syndrome and perinatal asphyxia. Mortality was in RDS mainly related to pneumothorax with septicaemia. Better obstetrical care and timely intervention may improve the outcome of newborn respiratory distress. Bangladesh Med J. 2019 Sep; 48 (3): 21-27

doi:10.3329/jafmc.v4i2.1839 JAFMC Bangladesh Vol.4(2) 2008 18-20