IntroductionPatients with severe malaria or sepsis are at risk of developing life-threatening acute respiratory distress syndrome (ARDS). The objective of this study was to evaluate point-of-care lung ultrasound as a novel tool to determine the prevalence and early signs of ARDS in a resource-limited setting among patients with severe malaria or sepsis.Materials and methodsSerial point-of-care lung ultrasound studies were performed on four consecutive days in a planned sub study of an observational cohort of patients with malaria or sepsis in Bangladesh. We quantified aeration patterns across 12 lung regions. ARDS was defined according to the Kigali Modification of the Berlin Definition.ResultsOf 102 patients enrolled, 71 had sepsis and 31 had malaria. Normal lung ultrasound findings were observed in 44 patients on enrolment and associated with 7% case fatality. ARDS was detected in 10 patients on enrolment and associated with 90% case fatality. All patients with ARDS had sepsis, 4 had underlying pneumonia. Two patients developing ARDS during hospitalisation already had reduced aeration patterns on enrolment. The SpO2/FiO2 ratio combined with the number of regions with reduced aeration was a strong prognosticator for mortality in patients with sepsis (AUROC 91.5% (95% Confidence Interval: 84.6%-98.4%)).ConclusionsThis study demonstrates the potential usefulness of point-of-care lung ultrasound to detect lung abnormalities in patients with malaria or sepsis in a resource-constrained hospital setting. LUS was highly feasible and allowed to accurately identify patients at risk of death in a resource limited setting.

Scrub and murine typhus are common, treatable causes of undifferentiated febrile illnesses in hospitalized patients.

Amino acid derangements are common in severe falciparum malaria and have been associated with endothelial dysfunction (L-arginine), metabolic acidosis (alanine and lactate), and disease severity (phenylalanine and tryptophan metabolites). Whether these amino acid perturbations reflect isolated pathogenic mechanisms or if they are part of overall changes in amino acid metabolism is unclear. To investigate this, we prospectively simultaneously quantified a broad range of plasma free amino acids (PFAA) using HPLC-MRM-Mass spectrometry in relation to presenting symptoms in adults with severe malaria (n = 88), septicaemia (n = 88), uncomplicated malaria (n = 71), and healthy controls (n = 48) from Bangladesh. The total plasma concentration of measured amino acids was significantly reduced in each of the patient groups when compared to normal levels observed in healthy local controls: uncomplicated malaria −54%, severe malaria −23%, and sepsis −32%, (p = <0.001). Inspection of amino acid profiles revealed that in each group the majority of amino acids were below normal levels, except for phenylalanine. Among patients with severe malaria, L-lactate was strongly associated with an increase of the total amino acid concentration, likely because this reflects tissue hypoxia. Our data confirm previously described amino acid abnormalities, likely resulting from overall changes in the concentration of PFAA.

Key words: rheumatic disorder; spectrum; teaching hospitalDOI: 10.3329/jcmcta.v20i1.4927 Journal of Chittagong Medical College Teachers' Association 2009: 20(1):6-11

Mammary tuberculosis is a rare entity in western countries but a continuing problem in endemic areas like Bangladesh. Its clinical patterns and treatment strategies are changing day by day. In this study we showed our clinical experience on 50 cases of mammary tuberculosis. This is a prospective nonrandomized observational descriptive study. A total of 50 consecutive adult female patients with no other co morbid diseases and who were diagnosed cytologically or histologically as case of mammary tuberculosis were enrolled in the study over a period of 04 years since 2006 to 2010 in general surgical unit of Chittagong Medical College Hospital and Chittagong general hospital. The average ages of presentation were 38 years. Ten(20%) patients were lactating at the time of presentation and six(12%) patients were nulliparious. 40(80%) patients had breast lump at presentation. Among them 20(40%) presented with multiple sinuses with lump,10(20%) had abscess with lump,05(10%) had abscess drainage scar with underlying lump and 05(10%) presented with isolated breast lump.06(12%) presented with multiple sinuses with abscess formation. Another 04(8%) patients had multiple sinuses only at presentation. Ten (20%) had constitutional symptoms in the form of fever, weight loss and night sweat. Twenty (40%) had axillary lymphaedenopathy in association with breast lesion. Diagnosis were confirmed by cytological and or histological findings of epitheloid granulomas.All patients were given antitubercular chemotherapy ( 9 months regimen) in combination with surgical intervention (45 out of 50 cases) as necessary in the form of excision of masses, incision and drainage of abscess and sinectomy. Mammary tuberculosis is a continuing problem in developing countries. Presentation may mimic benign lesion or carcinoma of the breast. Diagnosis can be made on high index of suspicion in endemic areas. Cytological or histological findings of granulomatous inflammation consisting of caseation necrosis, epitheloid cell and Langhans giant cell can give definitive diagnosis. Treatment is by anti tubercular chemotherapy with or without surgical intervention where necessary.